Perineal reconstruction with V-Y advancement flap at the general hospital of Mexico: a case report

Extramammary Paget's disease represents a rare entity whose only definitive management is resection, resulting in significant raw areas requiring reconstruction by the plastic surgeon. Currently, bilateral gluteal advancement VY fasciocutaneous flaps have been for some time one of the best options for perineal reconstruction, allowing for adequate coverage, low morbidity at the donor site, and satisfactory aesthetic and functional outcomes. In this study, we report the performance of a bilateral VY advancement flap for perineal reconstruction in the Plastic and Reconstructive Surgery Department of the General Hospital of Mexico.

The Influence of Late Pregnancy Perineal Massage Combined with Hip Training on Labor Outcomes and Psychological Elasticity of Primiparous Pregnant Women / 实用医学杂志

Objective To investigate the effects of perineal massage combined with hip joint exercise on the outcome of delivery and mental resilience of primipara.Methods 90 pregnant women in the third trimester(after 36 weeks)who obtained the knowledge about perineal massage from midwife clinic were randomly divided into two groups with 45 cases each.The control group received regular antenatal examination and family self-exercise;the experimental group received perineal massage and hip joint training combined treatment.The delivery outcome,birth experience and maternal mental resilience of the two groups were compared.Results the number of vaginal delivery in the experimental group were higher than that in the control group(P<0.05);the second stage of labor was significantly shorter than that of the control group(P<0.05);the perineal integrity rate was higher than that of the control group(P<0.05);the scores of all dimensions in delivery experience questionnaire were higher than that of the control group(P<0.05);the scores of all dimensions in maternal mental resilience were higher than those of the control group(P<0.05)after intervention.Conclusion The perineal massage which conducted by midwives combined with hip movement can effectively improve the quality of delivery,relieve the negative emotions of pregnant women,improve the psychological elasticity level of pregnant women,and improve the delivery outcomes.

Clinical study of precise prostate puncture by perineal color ultrasound combined with magnetic resonance in the diagnosis of prostate cancer / 中国现代医生

@#Objective To explore the clinical effect of perineal color ultrasound combined with magnetic resonance imaging(MRI)in the diagnosis of prostate cancer.Methods A retrospective analysis was performed on 80 patients with prostate biopsy in our hospital from July 2020 to September 2022.According to different puncture methods,they were divided into transrectal prostate biopsy(TRPB)group(40 cases)and transperineal prostate biopsy(TPPB)group(40 cases).With pathological examination results as the gold standard,puncture time,puncture needle number,puncture positive needle number,pathological examination results,Gleason score and complication rate of the two methods were analyzed,and the diagnostic value of TRPB and TPPB in prostate cancer was also analyzed.Results There were no significant differences in the number of puncture needles,the number of puncture positive needles,the malignant rate of pathological examination and Gleason score between the two groups(P>0.05).The puncture time in TRPB group was longer than that in TPPB group(P<0.05).The incidence of postoperative fever and puncture point bleeding in TRPB group was higher than that in TPPB group,and the incidence of pain was lower than that in TPPB group,with statistical differences(P<0.05).There was no significant difference in the incidence of hematuria and lower urinary tract symptoms between the two groups(P>0.05).The accuracy of TPPB method in the diagnosis of prostate cancer was 92.5%higher than that of TRPB method(75.0%),with statistical difference(P<0.05).There was no significant difference in sensitivity and specificity between the two methods for diagnosis of prostate cancer(P>0.05).Conclusion The application of perineal color ultrasound combined with MRI precision prostate puncture has high application value in the diagnosis of prostate cancer,which can effectively reduce the risk of complications such as fever and puncture point bleeding,shorten the operation time,and have high safety,which is worthy of promotion and application.

Medical illustration: a pictorial essay visual illustration of obstetric anal sphincter injuries (OASIS) degrees of severity, a picture is worth a thousand words

Obstetric anal sphincter injury affects about 5.7% of primiparous women who deliver vaginally. Perineal injury during childbirth is a common event with important morbidity associated with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries -OASIS). As there was a lack of consistency in the classification of a partial anal sphincter injury, with up to 33% of consultant obstetricians classifying a complete or partial tear of the EAS as a second-degree tear. We have proposed simple, digital diagrammatic drawings to visually represent all degrees (grades) of OASIS based on the WHO OASIS classification. (AU)

A prospective, randomized, single blind study comparing polyglactin-910 fast suture and chromic catgut suture in episiotomy repair

Background: Episiotomy is a standard surgical procedure performed during childbirth to enlarge the vaginal opening and facilitate baby delivery. Effective suturing techniques promote optimal wound healing, minimize complications, and enhance postpartum recovery for women undergoing episiotomy repair. This study aims to compare the effect of two different suture materials- chromic catgut and fast absorbable polyglactin-910 in the repair of episiotomy and its complications.Methods: A prospective, randomized, single blinded study was conducted at the department of obstetrics and gynecology, in a tertiary care hospital in India, between April 2021 and September 2022. Women aged 18-35 years with a singleton pregnancy undergoing vaginal delivery with episiotomy were included after giving informed written consent and fulfilling inclusion and exclusion criteria. Either chromic catgut (n=58) or polyglactin-910 fast (n=58) suture was used in episiotomy repair. The primary endpoint was to assess perineal pain following episiotomy repair using (VAS) visual analogue scale. The secondary endpoints were to assess wound healing using the REEDA scale, short term complications (hematoma, swelling, puerperal fever, dehiscence, wound healing and re-suturing), long term complications (feeling of slight stitches, dyspareunia and suture granuloma), intraoperative suture parameters, and any adverse events were noted.Results: Perineal pain, analgesic requirement, a feeling of slight stitches, and swelling were significantly more in the chromic catgut suture group compared to the polyglactin-910 fast absorbable suture group.Conclusions: The study concluded that polyglactin-910 fast absorbable suture is superior to chromic catgut suture and recommended its use over chromic catgut suture.

Angiomiofibroblastoma vulvoperineal, presentación de un caso / Vulvoperineal angiomyofibroblatoma, a case report

An angiomyofibroblastoma is a benign tumor that may present itself in the genital tract of a reproductive age woman. Despite it being a benign neoplasia, unable to be invasive, it can reach large sizes, producing discomfort, pain, and anatomical deformation. A late diagnosis may result in increased surgical difficulty for resection. The following is the clinical case of a woman with a vulvo-perineal tumor of 6 years of evolution, with a final diagnosis of angiomyofibroblastoma, in which complete resection of the lesion was achieved with good cosmetic results. The highlight of this tumor is its slow, silent, but progressive growth, leading to diagnoses that are often confused and late, with a consequent delay in treatment. Among the common differential diagnoses are the Bartholin gland cyst and the aggressive angiomyxoma.

El angiomiofibroblastoma es un tumor benigno que puede presentarse en el tracto genital de la mujer en edad reproductiva. A pesar de ser una neoplasia benigna, sin capacidad invasora, puede alcanzar grandes tamaños, produciendo molestia, dolor y alteración importante de la anatomía. Si el diagnóstico es tardío, aumenta la dificultad quirúrgica en su resección. A continuación, se presenta el caso clínico de una mujer con un tumor vulvoperineal de 6 años de evolución, con diagnóstico final de angiomiofibroblastoma, en el que se logró la resección completa de la lesión con un buen resultado estético. La importancia de este tumor está dada por su crecimiento lento, silencioso, pero progresivo, llevando a que su diagnóstico sea en muchas ocasiones confuso y tardío, con el consecuente retraso en el tratamiento. Dentro de los diagnósticos diferenciales comunes se encuentran el quiste de la glándula de Bartholino y el angiomixoma agresivo.

PERINEOTOMY CARE AFTER CHILDBIRTH

Every woman who became pregnant has to undergo the process of delivery. In normal process of delivery the baby is delivered per vagina, an episiotomy is performed by health care provider or midwife. Episiotomy is a surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labour to enlarge the vaginal introits so as to facilitate easy and safe delivery of the fetus. Episiotomy may be advice in the situations such as inelastic perineum, fetal distress, and complicated birth, prolonged second stage of labor, instrumental vaginal delivery and previous perineal surgeries .There are four types of episiotomy: midline, mediolateral, lateral and J shaped. Care of episiotomy involves perineal care, sitz bath, infrared heat, perineal exercises, antiseptic ointments, cold and hot packs The REEDA scale is used for assessing the perineal healing. Complications of episiotomy include perineal discomfort, perineal pain, difficulty with breast feeding and walking, perineal bleeding, infection, wound dehiscence and dyspareunia

Efficacy evaluation of radiofrequency thermocoagulation and pulse radiofrequency for the ganglion impar in treating primary perineal pain / 西安交通大学学报(医学版)

【Objective】 To compare the efficacy of radiofrequency thermocoagulation and pulsed radiofrequency for the ganglion impar in treating primary perineal pain. 【Methods】 We analyzed 79 patients with primary perineal pain who underwent radiofrequency thermocoagulation (group A) and pulsed radiofrequency (group B) in the ganglion impar from January 2020 to March 2022. VAS, excellent and good rates, sleep quality, postoperative medication usage, complications, and recurrence were evaluated before and 24 h, 1 W, 1 M, 3 M and 6 M after operation. The differences between the two groups were compared. 【Results】 The VAS score of group A gradually decreased at each level after operation, and the VAS score of group B gradually increased after 24 hours of operation. The differences between the two groups began to appear 1 week after operation, and the differences further increased with the extension of time (P<0.001). In six months after follow-up, the excellent and good rates of group A (86%) was significantly higher than that of group B (22%). In addition to postoperative perineal skin numbness, group A was superior to group B in improving sleep, postoperative oral medication (pregabalin and opioids), and disease recurrence (P<0.05). 【Conclusion】 Radiofrequency thermocoagulation for the ganglion impar can improve the quality of life by reducing pain, improving the excellent and good rates, improving sleep, and reducing recurrence a medication. The effect is better than that of pulsed radiofrequency.

Development of a perineal pain management scheme after vaginal delivery based on integrated maternity and childbirth / 现代临床护理

Objective To propose an integrated management scheme for perineal pain after vaginal delivery.Methods Literature review and Delphi inquiry were conducted to propose the perineal pain management scheme after vaginal delivery from November 2022 to April 2023.A total of 21 experts were consulted with 2 rounds of correspondence.Results Questionnaires collected from the two rounds of correspondence consultations were both at 100.0%.The expert authority coefficients for the two rounds were 0.930 and 0.935,respectively,with the expert coordination coefficients of the two rounds at 0.109(P<0.001)and 0.392(P<0.001),full mark rate 100%.A total of 3 primary items,15 secondary items and 40 tertiary items were summarised for the perineal pain management scheme after vaginal delivery in relation to prenatal prophylaxis,intrapartum protection and postnatal treatment.Conclusions The developed perineal pain management scheme after vaginal delivery is scientific and reliable.It provides a scientific reference for the prevention and treatment of perineal pain after vaginal delivery.

Effectiveness and safety of local anesthesia in patients with PI-RADS score 5 and ECOG score ≥2 for prostate puncture / 中华泌尿外科杂志

Objective:To investigate the effect of local anesthesia in patients with a PI-RADS score of 5 and ECOG score ≥2 for prostate puncture.Methods:Retrospective analysis of case data of 33 patients admitted to the Subei People's Hospital for prostate puncture from April 2020 to April 2022. Age (82.5±3.6) years. There were 18 cases with hypertensive disease, 8 cases with diabetes mellitus, and 6 cases with both diabetes mellitus and hypertensive disease. Body mass index (25.2±3.5) kg/m 2. prostate-specific antigen (PSA)(131.5±69.7) ng/ml. prostate volume (38.5±21.4) ml. all patients had a PI-RADS score of 5 on multiparametric magnetic resonance (mpMRI) and an Eastern Cooperative Oncology Group (ECOG) score ≥2. All 33 cases in this group underwent trans-perineal targeted prostate puncture using local anesthesia at the tip of the prostate. The visual analog score (VAS) and visual numeric score (VNS) were applied by the same surgeon to assess the patient's pain level and satisfaction at the time of puncture (VAS-1 and VNS-1) and 30 min after puncture (VAS-2 and VNS-2), and to record the duration of the procedure and the occurrence of postoperative complications. Results:In this group of 33 cases, the VAS-1 score was (1.9±0.3) and the VAS-2 score was (0.1±0.2); the VNS-1 score was (2.9±0.2) and the VNS-2 score was (3.9±0.1). Postoperative pathological results indicated that one of the 33 patients had a negative puncture result (pathology report indicating interstitial inflammation), while the rest of the patients had a positive puncture pathology report (puncture pathology report indicating prostate cancer), with a positive rate of 97%. One case of postoperative carnal haematuria occurred, which gradually improved after the patient was advised to drink water and take alpha-blockers. No perineal hematoma occurred, and all patients did not suffer complications such as urinary tract infection, urinary retention, azoospermia, vagal reaction, and infectious shock.Conclusion:In patients with a PI-RADS score of 5 and ECOG score ≥2, the use of single-hole local anesthesia for performing trans-perineal targeted puncture biopsy has the advantages of good paroxysmal pain and high safety.

Application value of transverse perineal arc incision approach in complete resection of presacral cyst in the lithotomy position / 中华消化外科杂志

Objective:To investigate the application value of transverse perineal arc incision approach in complete resection of presacral cyst in the lithotomy position.Methods:The retrospec-tive cohort study was conducted. The clinicopathological data of 114 patients who underwent com-plete resection of presacral cyst in Henan Cancer Hospital from August 2012 to October 2021 were collected. There were 14 males and 100 females, aged (35±9)years. All patients were diagnosed as presacral cysts by preoperative magnetic resonance imaging. Of the 114 patients, 76 patients undergoing intraoperative perineal arc incision approach in the lithotomy position were divided into the innovative group, and 38 patients undergoing intraoperative Kraske approach were divided into the traditional group. Observation indicators: (1) surgical situations and specimen; (2) postoperative situations; (3) Follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and com-parison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Surgical situations and specimen. The operation time, volume of intraoperative blood loss, cases with intraoperative combined transabdominal approach or sacrectomy were (137±20)minutes, (261±101)mL, 0 in the innovation group, versus (136±34)minutes, (261±116)mL, 15 in the tradi-tional group, showing no significant difference in the operation time and volume of intraoperative blood loss between the two groups ( t=0.18, 0, P>0.05) and showing a significant difference in cases with intraoperative combined transabdominal approach or sacrectomy between the two groups ( P<0.05). Results of postoperative specimen anatomy in patients of the two groups showed complete removal of the cyst. (2) Postoperative situations. The time to postoperative removing presacral drainage tube, duration of postoperative hospital stay, cases with postoperative second stage healing of incision were (11.4±2.1)days, (13.5±3.5)days, 23 in the innovation group, versus (11.5±1.9)days, (13.7±3.8)days, 4 in the traditional group, showing no significant difference in the time to post-operative removing presacral drainage tube and duration of postoperative hospital stay between the two groups ( t=-0.20, -0.24, P>0.05) and showing a significant difference in cases with postoperative second stage healing of incision between the two groups ( χ2=5.46, P<0.05). Cases with postoperative severe complications were 4 and 2 in the innovation group and the traditional group, respectively, showing no significant difference between the two groups ( P>0.05). (3) Follow-up. All 114 patients were followed up for 48(range, 6?108)months. Cases with recurrence of cysts were 2 and 0 in the innovation group and the traditional group, respectively, showing no significant difference between the two groups ( P>0.05). During the follow-up period, the anal defecation control function of all patients was classified as grade A?B of Williams score. Conclusions:The transverse perineal arc incision approach in complete resection of presacral cyst in the lithotomy position is safe and feasible. Compared with Kraske approach, the transverse perineal arc incision approach in the lithotomy position is more suitable for patients with high presacral cyst.

Resultados del taller para residentes de ginecoobstetricia en reparación de episiotomías y desgarros obstétricos / Results of workshop for obstetrics and gynecology residents on episiotomy and injury obstetric tear repair

Resumen OBJETIVO: Evaluar los conocimientos, satisfacción y nivel de confianza de los médicos residentes de Ginecología y Obstetricia luego de haber participado en un taller de simulación de reparación de episiotomías y desgarros perineales severos. MATERIALES Y MÉTODOS: Estudio observacional y transversal efectuado en residentes de la especialidad de Ginecología y Obstetricia en junio del 2022. Se aplicaron cuestionarios de conocimientos antes y después del taller, una encuesta de satisfacción y nivel de confianza, así como una lista de cotejo para valorar el desempeño en la ejecución de la técnica de reparación de episiotomías y desgarros. Se utilizó estadística descriptiva y prueba de t pareada para la comparación antes y después de las muestras relacionadas. Se consideró significancia estadística una p < 0.05. RESULTADOS: Se incluyeron 37 médicos residentes de todos los grados académicos. La media de la evaluación preprueba fue de 14.89 ± 0.54 puntos y 15.81 ± 0.41 puntos en la posprueba (p = 0.233). Durante la práctica de reparación de la episiotomía, 34 de los 37 residentes reconocieron estructuras anatómicas y todos seleccionaron adecuadamente el material de sutura. En el taller de desgarros perineales 25 de 37 reconocieron las estructuras anatómicas y todos, menos uno, seleccionaron adecuadamente el material. CONCLUSIONES: El taller con modelos animales de simulación tiene un alto grado de satisfacción y nivel de confianza; sin embargo, en este estudio no se observó mejoría en los conocimientos. Este efecto positivo en los médicos en vías de especialización permite identificar, de manera oportuna, las lesiones del esfínter anal, llevar a cabo una correcta reparación y, en consecuencia, disminuir la incidencia de disfunciones asociadas con el traumatismo obstétrico perineal.

Abstract OBJECTIVE: To assess the knowledge, satisfaction and level of confidence of Gynaecology and Obstetrics residents after participating in a simulation workshop on episiotomy and severe perineal tear repair. MATERIALS AND METHODS: Observational and cross-sectional study carried out in residents of the speciality of Gynaecology and Obstetrics in June 2022. Knowledge questionnaires were administered before and after the workshop, a satisfaction and confidence level survey, as well as a checklist to assess the post-workshop episiotomy and tear repair technique. Descriptive statistics and paired t-test were used for pre- and post-test comparison. A p < 0.05 was considered statistically significant. RESULTS: Thirty-seven resident physicians of all academic grades were included. The mean pre-test assessment was 14.89 ± 0.54 points and 15.81 ± 0.41 points at post-test, p = 0.233. During episiotomy repair practice, 34 of the 37 residents recognized anatomical structures and all selected suture material appropriately. In the perineal tears workshop 25 of 37 recognized anatomical structures and all but one selected material appropriately. CONCLUSIONS: The workshop with simulation animal models has a high satisfaction and confidence level; however, no improvement in knowledge was observed in this study. This positive effect on trainee doctors allows early identification of anal sphincter injuries, correct repair and consequently a decrease in the incidence of dysfunction associated with perineal obstetric trauma.

Episiotomy scar endometriosis: A case report and review of literature

Endometriosis is defined as the presence and growth of endometrial tissue implants, outside the uterine cavity. It is in a episiotomy scar endometriosis that is extremely rare but can lead to significant morbidity in patients due to local infiltration. This condition usually presents with a clinical triad of history of episiotomy, tender nodule at the scar site, and cyclical pain. Here, we report one such rare case of episiotomy scar endometriosis in the perineum of a 30-year-old young female (P1L1) who presented with swelling and pain in the perineal region. The clinical examination and ultrasonography corroborate with the diagnosis of episiotomy scar endometriosis. Excision was done and histopathological examination confirmed the diagnosis. Episiotomy scar endometriosis should always be kept in the differential diagnosis when a lady presents with painful perineal swelling which increases during menstruation. Wide local excision is the treatment of choice and confirmation of the lesion can be done with histopathological examination. If the lesion is not diagnosed within a stipulated period of time, can progress with the involvement of the anal sphincters, and may also turn into a malignant lesion.

Yonishaithilya (Perineal Laxity) - A Comprehensive Review

Yonishaithilya is a common gynecological problem of women of contemporary era which has very important impact on female’s sexual function. This must not be taken lightly as they can adversely affect the quality of woman’s life. As per Brihatrayi, Yonishaithilya represents as a symptom of Mahayoni Yonivyapada, Vatala Yonivyapada, Phalini Yonivyapada and Karnini Yonivyapada, not as a separate disease. Etiology, sign, symptoms and treatment of Yonishaithilya resembles with perineal laxity. Perineal laxity is the condition where there is loosening of supporting structure of female pelvis, thereby allowing the descent of one or more pelvic organ through the lax vaginal introitus. Data Source: Brihatrayees and Laghutrayees, also from all contemporary textbooks, Relevant journals and Websites; Review method: Literary review; Objective:. This review article summarizes details of Yonishaithilya, current scientific researches and elaborates the various therapeutic procedure and drug formulations suggested in Ayurveda for the treatment of Yonishaithilya. Scope and Conclusion: Ayurveda gives various Panchakarma and Sthanik chikitsa like local application of Pichu, Snehana Swedana which are economical, easy and nonsurgical; many single plants; herbal formulations used traditionally which gives an eminent result in Yonishaithilya. Untreated Yonishaithilya may produces complications like pelvic organ prolapse, urinary incontinence and may convert into 2nd or 3rd-degree prolapse where conservative treatment is not beneficial. In some cases, a patient has been advised for a hysterectomy but the patient is reluctant to undergo surgery. So, it is preferred to try Ayurvedic medicine which may be the step to avoid hysterectomy. So, it is necessary to treat it as early as possible.

Development of a constant temperature disinfection device and evaluation of its clinical application effect / 中国实用护理杂志

Objective:To develop a constant temperature disinfection device and evaluate its clinical effect in perineal disinfection after delivery.Methods:A total of 300 cases of puerpera who met the inclusion and exclusion criteria were selected from Heping Hospital Affiliated to Changzhi Medical College from November to December 2020. The study was designed as a randomized control study. Subjects were randomly divided by random digit table into the control group and the experimental group of 150 cases respectively. The former used conventional methods for perineal disinfection after delivery. The latter performed perineal disinfection assisted by a thermostatic disinfection device. The temperature comfort of perineal disinfection and the perineal wound healing of perineal tear or lateral incision were compared between two groups.Results:The score of temperature comfort feeling of puerpera in the control group and the experimental group was 3 (1.5) and 5 (0), respectively. The maternal temperature comfort feeling score in the experimental group was higher, and the difference between the two groups was statistically significant ( Z=-13.78, P<0.05). There was no grade C healing of perineal wounds in the two groups. The composition ratios of grade A and grade B healing of perineal wounds in the control group were 89.61% (69/77) and 10.39% (8/77), and those in the experimental group were 93.75% (90/96) and 6.25% (6/96). The healing of perineal wound in the latter group was better, but the difference between the two groups was not statistically significant ( Z=0.99, P>0.05). Conclusions:The constant temperature disinfection device meets the clinical nursing needs, enhances the comfort experience of puerpera, and has certain effect on promoting the healing of perineal wound after delivery.

Effect of interrupted suture and continuous suture on perineal rehabilitation of parturients: a Meta-analysis / 中国实用护理杂志

Objective:To explore the effect of perineal lateral incision and continuous suture of deep and superficial Ⅱdegree laceration on postoperative perineum rehabilitation of parturients.Methods:Randomized controlled trials of intervention effects on postoperative maternal wound rehabilitation using continuous sutures and interrupted sutures of mucosal, muscle, and skin layers after perineal lateral resection and Ⅱdegree lacerations were searched in Cochrane Library, PubMed, Medline, Embase, Science direct, China Biology Medicine, China National Knowledge Infrastructune, Wanfang Database, VIP Database. The retrieval time limit was from database establishment to October 1, 2020. using RevMan 5.3 software for statistical processing.Results:After searching and screening, 12 articles were finally included. The total sample size was 2 827 cases. After the two groups used different suture techniques, the results of Meta analysis showed that the pains ( MD=1.02, 95% CI=1.02-1.06), the suture time ( MD=-4.59, 95% CI=-7.29 - -1.91) and the healing condition ( MD=-0.55, 95% CI=-0.71 - -0.39) of the two groups were compared, the differences were significant (all P<0.01). Conclusions:In the suture of perineal lateral incision and Ⅱdegree laceration, continuous suture technique is used to suture the mucosal layer, muscle layer, and cortex, which can reduce the suture time, reduce the pain of the parturient, and is beneficial to the healing of the wound. It can be clinically based on the parturient. It can be used in accordance with the neatness and depth of the mouth and the needs of the parturient.

A case-control analysis of perineal hematoma and its risk factors in pregnant women undergoing vaginal delivery / 中国实用护理杂志

Objective:To provide data support for preventing its occurrence and developing scientific and effective nursing intervention by investigating the situation and risk factors of perineal hematoma in pregnant women undergoing vaginal delivery through retrospective case-control study.Methods:A total of 102 parturients who had perineal hematoma during vaginal delivery in Shanghai Maternity and Infant Hospital Affiliated to Tongji University were selected as the hematoma group, from October 2018 to March 2020, and case control study ( n=204) was performed in the ratio of 1∶2. 24 possible influencing factors were determined by literature review and expert consultation and the data were collected retrospectively by clinicopathology. Single factor analysis, t test, Chi-square test and Multivariate binary Logistic regression analysis were used to identify factors related to perineal hematoma, and to explore potential risk factors of perineal hematoma. Results:From October 2018 to March 2020, there were 18 292 cases of vaginal delivery, including 102 cases of perineal hematoma, with an incidence of 0.56%. Single factor analysis showed 10 risk factors pertinent to perineal hematoma were selected ( t/ χ2 values were -4.51 to 31.79, all P<0.05); and multiple Logistic regression analysis showed the risk factors of perineal hematoma in vaginal delivery were old puerperal ( OR=7.53, P<0.05) and perineal edema ( OR=3.10, P<0.05), and the protective factors were free position delivery ( OR=0.35, P<0.05) and concomitant delivery ( OR=0.31, P<0.05). Conclusions:The incidence of perineal hematoma is relatively high in pregnant women undergoing vaginal delivery, usually occurrs on the right side of the perineal vagina and within 2 hours after delivery. Clinically, it is necessary to actively promote quality nursing services at midwifery to reduce the incidence of perineal hematoma.

Clinical analysis of Delorme procedure for full-thickness rectal prolapse / 中国医师进修杂志

Objective:To evaluate the safety and efficacy of Delorme procedure for adults with full-thickness rectal prolapse.Methods:Clinical data of 17 adult patients suffering from full-thickness rectal prolapse undergoing Delorme procedure from June 2014 to May 2018 in Hangzhou Third Hospital were retrospectively analyzed. Patient characteristics, operative data, postoperative complications, recurrence of rectal prolapse, continence state and constipation state were evaluated.Results:Eleven patients were female, 6 patients were male with a mean age of (68 ± 9) years. Operations were successfully performed in these 17 cases. The operation time was (88 ± 16) minutes. The estimated blood loss during operation was (23 ± 9) ml. The postoperative time of hospital stay was (8 ± 1) d. Two complications in two patients were observed. There was no treatment related death. One recurrent case was observed during (16 ± 2) months follow-up. The preoperative and postoperative mean constipation score of five patients with fecal constipation were (23 ± 2) and (11 ± 3) respectively ( t = 9.51, P<0.01). The mean fecal incontinence score of six patients with fecal incontinence, before and after Delorme procedure, were (14 ± 2) and (6 ± 2) respectively ( t = 9.09, P<0.01). Conclusions:The Delorme procedure for adults with full-thickness rectal prolapse is a safe and effective surgery with less complications and low recurrence rate. The Delorme procedure may be one of the preferred option of perineal approach for adults with full-thickness rectal prolapse, but the long-term outcome of Delormer procedure and its effect on postoperative anal function need to be further studied.

Gracilis musculocutaneous flap in repair of perineal soft tissue defect with open pelvic fracture / 中华显微外科杂志

Objective:To investigate the clinical effect of gracilis musculocutaneous flap in repair of perineal soft defect with open pelvic fracture.Methods:From June 2009 to June 2019, 11 cases of open pelvic fracture associated with perineal injury were treated in the Department of Trauma and Orthopaedic of 521 Hospital of Norinco Group. There were 4 males and 7 females aged 16-56 (33 in average) years old. Cause of injuries: 6 cases by traffic accident, 4 by falling from height, and 1 by crushing. All the patients had open pelvic fractures. According to Tile classification, 1 case was rated as type A, 7 as type B and 3 as type C. All the patients were accompanied with perineal injury and soft tissue defect. The wound sizes ranged from 5 cm×5 cm to 8 cm×12 cm. The defects were repaired with gracilis musculocutaneous flap. The size of gracilis myocutaneous flaps was 6 cm×5 cm to 9 cm×13 cm. All donor areas of the flap were sutured directly. After surgery, 11 patients treated with strengthened nutritional support, keep supine position to avoid abduction, and appropriately raise the lower limbs. Follow-ups were conducted regularly after surgery.Results:All patients entered 6 to 30 (22 in average) months of follow-up. All of 11 myocutaneous flaps survived, besides 1 had a few necrosis at the distal surface of the myocutaneous flap, and healed after change of dressing. All the incisions at donor site had stage I healing. The colour, texture and flexibility of the gracilis myocutaneous flap were good. There was a scar at the donor sites without causing obvious dysfunction. Over the follow-up period, there was no failure of flap in either the recipient and donor sites. The patients were satisfied with the appearance and function.Conclusion:Gracilis musculocutaneous flap is one of the ideal methods in repair of perineal soft tissue defect with open pelvic fracture.

Maternal factors and short-term outcome associated with episiotomy during vaginal delivery at the Women and Newborn Hospital, Lusaka, Zambia

Objective:To explore the maternal factors and short-term outcomes associated with episiotomy during vaginal delivery at Women and Newborn Hospital, Lusaka, Zambia.Materials and Methods:An unmatched case control study was conducted in postnatal wards of Women and New-born hospital in Lusaka, Zambia between November 2019 and April 2020 with convenient sample for the cases and systematic sample for the controls.Asemi-structuredintervieweradministered questionnaire was used and 102 participants (cases) who had episiotomy performed were recruited while 204(controls) werewithoutepisiotomy.Results:Atotal of 306 (102 are cases and 204 are control) were included. Age was found to be a good predictor of episiotomy in that those younger than 18 years were more than seven times likely to have an episiotomy (AOR=7.65; 95%CI 1.36-18.21; p=0.035). It was also found out that primi gravidas were five times likely to have an episiotomy performed compared to parous women (OR=4.96; 95%CI 2.58-9.52; p<0.001). Out of those delivered by a midwife, 73(28.3%) participants had an episiotomy performed compared to 29(60.4%) deliveredbyamedicalofficer.Multivariateregression it was shown that being delivered by a midwife was protective against an episiotomy (OR=0.260; 95%CI 0.14-0.49; p=0.001). Out of the 102 participants who had an episiotomy, only two had third degree tear extension. It was also noted that 99 out of 102 (97%) participants who had an episiotomy experienced post-delivery perineal pain compared to 94 out of 204(46%) of those who had no episiotomies. In univariate analysis, it was found that post-delivery perineal pain was associated with episiotomy (p<0.001). It was further found that those who had an episiotomy performed were about 4 times likely to experience perineal pain post- delivery (OR=3.8; 95%CI 1.2-12.3) Conclusion:Maternal factors associated with episiotomy includedage,parity,method of induction,and the personnel conducting the elivery. Shorttermmaternaloutcomesofepisiotomy were perineal tear extension, and post-delivery perineal pain. It was found that 8.5% of women had undergone an episiotomy done on them. Health professional conducting deliveries should be educated on indications of episiotomy, patient selection during episiotomy and trained on surgical skills to repair episiotomy to reduce morbidity associated the procedure.