Postpartum perineal pain and dyspareunia related to each superficial perineal muscle injury: a cohort study.

OBJECTIVE: To assess the association between superficial perineal muscle trauma and perineal pain and dyspareunia. MATERIALS AND METHODS: Prospective cohort study of 405 women with a spontaneous vaginal birth comparing an intact perineum and first-degree perineal trauma group (n = 205) with a second-degree perineal trauma and episiotomy group (n = 200). Perineal pain was measured at 2 days, 10 days, 7 weeks, 3 months and 6 months postpartum. Dyspareunia was assessed at 7 weeks, 3 months and 6 months postpartum. RESULTS: All second-degree perineal traumas and episiotomies involved damage to the bulbospongiosus muscle (BSM), but not always to the superficial transverse perineal muscle (STPM). In case of second-degree trauma or episiotomy, the odds of pain at 10 days and dyspareunia at 6 months postpartum were four- and five-fold greater, respectively, than if the perineum had remained intact or suffered a first-degree perineal trauma [OR 4.4 (95% CI: 2.8-6.9) and OR 5.5 (95% CI: 2.8-10.9), respectively]. When comparing injuries where > 50% BSM ± STPM against those with < 50% BSM torn, pain was significantly higher at 10 days postpartum [OR 1.9 (95% CI: 1.1-3.6], with no difference at 7 weeks, while dyspareunia was significantly higher at 6 months postpartum [OR 3.3 (95% CI: 1.4-7.8)]. There was no difference in perineal pain or dyspareunia when comparing first-degree with < 50% BSM traumas. CONCLUSION: When perineal muscle trauma encompasses > 50% BSM ± STPM, perineal pain and dyspareunia persisted until 10 days and 6 months postpartum, respectively.

Trabajo en equipo en el grado de Enfermería. Evaluación. Validación de un instrumento para su medición / Teamwork in the nursery degree: evaluation

El cuestionario que se presenta ha sido desarrollado y validado por miembros del Grupo de Innovación Docente Consolidado (GIDC) Grup d'Infermeria Orientat a Tècniques Educatives Innova-dores (GIOTEI) reconocido por el Programa de Millora i Innovació Docent (PMID) de la Universitat de Barcelona (UB).El propósito del estudio es aportar la descripción y resultados de un proceso de validación del instrumento GIOTEI-UB, creado para medir la competencia transversal trabajo en equipo en la formación de grado de Enfermería. Las pruebas psicométricas que se presen-tan comportan una segunda ronda de validación. Se trata de un cuestionario integrado por 39 ítems distribuidos en seis dimensiones y subescalas que valoran la participación en el trabajo en equipo desde la percepción de los estudiantes, a partir de la realización de actividades y de las habilidades interpersonales. Ha sido suministrado a estudiantes de los cuatro cursos del grado de Enfermería en el curso académico 2015-2016, en modalidad online a través del campus virtual de la UB. Las respuestas obtenidas son n=450 a través de la evaluación por pares y n=344 a través de autoevaluación. En general, los resultados muestran la validez y fiabilidad del cuestionario. Su aplicación ha mostrado el potencial evaluativo y también formativo del instrumento, plausible de ser contemplado para la docencia y la investigación en educación superior

The questionnaire presented was developed and validated by members of a Consolidated Teaching Innovation Group (GIDC) Grup d'Infermeria Orientat a Tècniques Educatives Innovadores (GIOTEI) recognized by the Millora i Innovació Do-cent Program (PMID) of the University of Barcelona (UB) The purpose of the study is to provide description and results of a second round of a validation process of the GIOTEI instrument, created to measure the transversal competency of teamwork in nursing degree training. It is a questionnaire composed of 39 items distributed in six dimensions or subscales that evaluate the participation in teamwork based on the realization of activities and interpersonal skills. It has been provided to students of the four classes of the Nursing degree in the academic year 2015-2016, in online mode through the virtual campus of the University of Barcelona. The answers obtained were n=450 through peer evaluation and n=344 through self-evaluation. In general, the results show good validity and reliability of the questionnaire. The application has shown the evaluative and formative potential of the instrument, eligible for consideration for teaching and research in higher education

Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Perineal pain and dyspareunia are experienced by women undergoing a vaginal birth that can have short and longer term physical and psychological morbidities. This review aimed to determine the incidence of perineal pain and dyspareunia following spontaneous vaginal birth (SVB) with intact perineum, first and second-degree perineal trauma or episiotomy. METHODS: Searches of MEDLINE, EMBASE, CINAHL, AMED and MIDIRS (inception - December 2017) were undertaken with selection criteria of any study evaluating the effect of intact perineum, first- or second-degree perineal trauma on perineal pain or dyspareunia in women with SVB. RESULTS: Eighteen studies (8 RCTs and 10 NRSs) were included. Fourteen and 12 studies were undertaken to assess perineal pain and dyspareunia after SVB, respectively. Meta-analysis of 16 studies (3133 women) demonstrated that women at 2 days postpartum experienced nearly the same incidence of perineal pain whether perineal trauma existed or not. At 4-10 days postpartum there was a significant reduction in the incidence of perineal pain for both presence and absence of any perineal trauma. Episiotomy was associated with the highest rate of perineal pain. The incidence of dyspareunia was high at resumption of sexual intercourse following SVB with an intact perineum. At 12 months, women still experienced dyspareunia whether perineal trauma existed or not. CONCLUSIONS: Women experience perineal pain and dyspareunia regardless of the presence or absence of perineal trauma after SVB; nonetheless, the reported incidence is higher if perineal trauma occurred.

Efficiency of the modified Sims maternal position in the rotation of persistent occiput posterior position during labor: A randomized clinical trial.

BACKGROUND: Fetal occiput posterior position in labor is associated with more painful and prolonged labor, and an increase in both maternal and fetal morbidity. The aim of this study is to assess whether the modified Sims position on the side of the fetal spine increases the rotation to occiput anterior position in women with epidural analgesia and a fetus in persistent occiput posterior (POP) position. METHODS: This is an open, randomized controlled, clinical trial. One hundred and twenty women in labor with fetuses in POP position were included. The diagnosis was performed through digital vaginal examination and confirmed with an ultrasound scan. Women were randomized into the free position group or the modified Sims on the side of the fetal spine. The primary outcome was rotation to occiput anterior, and secondary outcomes were type of delivery, postpartum perineal condition, perinatal results, and maternal satisfaction. RESULTS: In pregnant women undergoing labor in the Sims position, fetuses in POP rotated to occiput anterior in 50.8% of cases, whilst in the free position group, the rotation occurred in 21.7% (P = .001). The rate of vaginal deliveries was higher in the Sims group compared with the free position group (84.7% vs 68.3%, P = .035). DISCUSSION: The modified Sims position is a maternal posture intervention efficient in POP rotation, which decreases cesarean delivery rate. It is a simple and noninvasive intervention, reproducible, and well tolerated by pregnant women.

Cuidado de las lesiones posparto en la consulta perineal / The role of a specialist clinic to care for childbirth related perineal trauma

El objetivo de este artículo fue revisar bibliográficamente los principales problemas que se derivan de las lesiones perineales, así como dar a conocer el trabajo de la matrona en una consulta perineal y el modo en que se está implementando esta consulta en el Hospital General de Granollers. Para cumplir con la primera parte del objetivo, se realizó una revisión bibliográfica sobre las complicaciones derivadas de las lesiones perineales que ocurren durante el parto. Los resultados obtenidos se han estructurado en los siguientes apartados: dolor perineal y dispareunia, infección y dehiscencia, incontinencia urinaria y prolapso genital (lesión del músculo elevador del ano) e incontinencia fecal y de gases (lesión del esfínter anal). En la segunda parte del artículo se explica la experiencia que se realizó en el Servicio de Obstetricia del Hospital de Granollers para disminuir la morbilidad posparto derivada de las lesiones perineales. Se implementaron diversas medidas de prevención, y se creó una consulta perineal para dar continuidad a los cuidados especializados para las mujeres que han sufrido alguna complicación perineal tras el parto vaginal. La matrona, integrada en el equipo multidisciplinario especialista en suelo pélvico, es la profesional que realiza este seguimiento y proporciona apoyo a la mujer

The objectives of this paper are twofold. Firstly, to review the morbidity associated with childbirth related perineal trauma (CRPT), and secondly, to outline the role of the Specialist Perineal Midwife and their integral role within a new Midwife-led Perineal Clinic in Hospital General de Granollers, Barcelona to care for women and reduce CRPT morbidity. The first part of this paper details the findings from a review of the literature on the CRPT morbidities of perineal pain and dyspareunia; perineal wound infection and breakdown; urinary incontinence and genital prolapse (levator ani muscle injury), and fecal incontinence (anal sphincter injury). The second part of this paper details the actions that have been implemented in the Obstetrics Service of the Hospital General de Granollers in order to reduce postpartum morbidity related to perineal injuries. These include the provision of a specialist perineal midwife who, through a dedicated perineal clinic, provides specialist care for women who suffer CRPT and is a core member of the perineal trauma/OASIS multi-disciplinary team

[CONTROL OF FETAL WELL-BEING: BIOPHYSICS INTRAPARTUM MONITORING]. / Control del bienestar fetal: monitorización biofísica intraparto.

This article presents an update on the control of the intrapartum fetal wellbeing including the following aspects: methods of monitoring the fetal heart rate and the uterine dynamic and uterine contraction parameters. Moreover, the assessment of intrapartum CTG records is described by analyzing the fetal heart rate in relation to uterine contractions. The different types of fetal heart rate decelerations: early late and variable, its clinical significance and the guidelines to follow in each one of them are evaluated. Finally, the parameters that make up a normal CTG registration are defined.

Control del bienestar fetal: monitorización biofísica intraparto / Control of fetal well-being: biophysics intrapartum monitoring

En este artículo se presenta una actualización sobre el control del bienestar fetal intraparto que comprende los siguientes aspectos: métodos de control de la frecuencia cardiaca fetal y de la dinámica uterina y parámetros de la contracción uterina. Asimismo, se describe la valoración de los registros cardiotocográficos intraparto analizando la frecuencia cardiaca fetal en relación con la dinámica uterina. Se evalúan los diferentes tipos de deceleraciones de la frecuencia cardiaca fetal: precoces, tardías y variables, su significado clínico y la conducta que seguir en cada una de ellas. Finalmente, se definen los parámetros que componen un registro cardiotocográfico normal (AU)

This article presents an update on the control of the intrapartum fetal wellbeing including the following aspects: methods of monitoring the fetal heart rate and the uterine dynamic and uterine contraction parameters. Moreover, the assessment of intrapartum CTG records is described by analyzing the fetal heart rate in relation to uterine contractions. The different types of fetal heart rate decelerations: early late and variable, its clinical significance and the guidelines to follow in each one of them are evaluated. Finally, the parameters that make up a normal CTG registration are defined (AU)

El impacto y la corrección de posiciones occipitoposteriores en el parto / The impact and correction of occiput posterior positions when giving birth

El objetivo de esta revisión bibliográfica es profundizar en la frecuencia, factores predisponentes, diagnostico, evolución, pronostico y medidas correctoras de las variedades posteriores de la cabeza fetal en el parto. Se hizo una búsqueda en las bases de datos PubMed, CINHAL, Cuidatge y Biblioteca Cochrane con los descriptores «occipitoposterior», «occiputposterior», «fetal malpresentations», «malposiciones fetales», «parto» y «labor»; se incluyeron los estudios, con cualquier tipo de diseño, publicados en los últimos 20 años en castellano o inglés .Los resultados reflejan variabilidad en los temas estudiados, excepto en la frecuencia. Las posiciones posteriores se asocian a una mayor morbilidad materno-fetal y a un trabajo de parto más doloroso, prolongado y difícil. Aunque estas posiciones no son una complicación grave ni son difíciles de tratar, tienen graves consecuencias para la madre y el hijo

The objective of this bibliographic review is to deepen into the corrective measures of the posterior positions. This is accomplished through the analysis of the predisposing factors, diagnosis, frequency, prognosis and its evolution. The research was conducted through the databases: PubMed, CINHAL, Cuidatge and the Cochrane Library; through studies with any type of design and in both English and Spanish languages. 152 articles were found, from which 40 were selected; these reflect variety in all the studied elements except for incidence. The posterior positions are associated with a higher materno-foetal morbidity, linked to a longer, more painful and complicated delivery. Even though these positions don’t necessarily lead to dangerous situations, they may still present severe consequences for the mother and the baby

Control del bienestar fetal. Monitorización biofísica anteparto / Control of fetal well-being: biophysics antepartaum monitoring

En este artículo se presenta una actualización sobre el control del bienestar fetal anteparto, que incluye la monitorización biofísica con el test no estresante y el test estresante y su valoración. Se describen los parámetros de la frecuencia cardiaca fetal -la línea de base, la variabilidad y los ascensos transitorios de la frecuencia cardiaca fetal- en relación con los movimientos fetales, su significado clínico y la actuación que deriva del mismo (AU)

This article provides an update on the control of antepartum fetal well-being, including the biophysical monitoring with nonstressful and stressful test and its evaluation. The fetal heart rate -base line, variability and transitional increases in fetal heart rate- are described based on fetal movements, its clinical meaning and actions derived from it (AU)

Aplicación de termoterapia en el periné durante el parto para reducir las lesiones que precisan sutura posparto / Application of perineum heat therapy during partum to reduce injuries that require post-partum stitches

OBJETIVO: Evaluar la eficacia de la termoterapia, húmeda o seca, en el periné durante el parto para reducir las lesiones que precisan sutura posparto y valorar su seguridad en relación a la adaptación del recién nacido a la vida extrauterina. MÉTODO: Ensayo clínico multicéntrico, abierto, dirigido desde la Escuela de Enfermería de la Universidad de Barcelona y realizado durante los años 2009-2010 en 5 hospitales catalanes. La muestra fue de 198 gestantes a las que se aplicó el protocolo para la asistencia natural al parto normal. Se realizó una asignación aleatoria a los 3 grupos de estudio: grupo control (GC), calor húmedo (GCH) o calor seco (GCS). Durante el expulsivo se realizó en todos los grupos el cuidado habitual del periné y en los grupos de intervención se aplicó, además, GCH o GCS en el periné. Posteriormente se valoró el estado del periné posparto y el test de Apgar en el neonato. Se realizaron pruebas de contraste estadístico utilizando un intervalo de confianza del 95% y análisis estadístico con PASW 17. RESULTADOS: Perinés sin sutura: GCH 71% (47) versus GC 56% (37), OR: 1.803 (IC:95%:0,881-3,687); GCS 62% (41) versus GC 56% (37), OR:1.285 (IC:95%:0,641-2,577); GCH 71% (47) versus GCS 62% (41), OR:1.402 (IC:95%:0,680-2,890). Medias test de Apgar 5', GCH: 9,91; GCS: 9,98; GC: 9,98. p = 0,431. CONCLUSIONES: La aplicación de termoterapia en el periné no redujo la sutura perineal durante el parto. Se obtuvieron mejores resultados perineales con la termoterapia húmeda. La termoterapia no modificó los resultados neonatales medidos mediante test de Apgar

OBJECTIVE: Evaluate the effectiveness of heat, moist or dry to the perineum during delivery in order to reduce injuries requiring perineal suturing after birth, and to assess its safety in relation to the adaptation of the newborn to extrauterine life. METHOD: An open multicentre clinical trial directed from the School of Nursing at the University of Barcelona was carried out between 2009 and 2010 in 5 Catalan Hospitals. The sample consisted of 198 pregnant women subjected to the natural protocol for normal delivery assistance. The pregnant women were randomized to three study groups: moist heat (MHG), dry heat (DHG), and control (CG). Usual care of the perineum was performed during labour in all groups and MHG or GCS was also applied in the perineum in the intervention groups. The Apgar score in the newborn and perineum postpartum was then assessed. Statistical tests were performed using a 95% confidence interval. Statistical analyses were performed using the SPSS version 17. RESULTS: Perinea that required no suturing: MHG 71% (47) versus CG 56% (37), OR: 1.803; (95% CI: 0.881-3.687); DHG 62% (41) versus CG 56% (37), OR:1.285 (95% CI: 0.641-2.577); MHG 71% (47) versus DHG 62% (41), OR:1.402 (95% CI: 0.680-2.890). Mean: Apgar score 5', MHG: 9.91; DHG: 9.98, CG: 9.98. p = 0.431. CONCLUSIONS: The application of heat therapy to the perineum during labour did not significantly reduce perineal suturing after birth. However, better perineal results were observed with moist heat. Heat therapy does not alter neonatal outcomes measured by Apgar score

[Application of perineum heat therapy during partum to reduce injuries that require post-partum stitches]. / Aplicación de termoterapia en el periné durante el parto para reducir las lesiones que precisan sutura posparto.

OBJECTIVE: Evaluate the effectiveness of heat, moist or dry to the perineum during delivery in order to reduce injuries requiring perineal suturing after birth, and to assess its safety in relation to the adaptation of the newborn to extrauterine life. METHOD: An open multicentre clinical trial directed from the School of Nursing at the University of Barcelona was carried out between 2009 and 2010 in 5 Catalan Hospitals. The sample consisted of 198 pregnant women subjected to the natural protocol for normal delivery assistance. The pregnant women were randomized to three study groups: moist heat (MHG), dry heat (DHG), and control (CG). Usual care of the perineum was performed during labour in all groups and MHG or GCS was also applied in the perineum in the intervention groups. The Apgar score in the newborn and perineum postpartum was then assessed. Statistical tests were performed using a 95% confidence interval. Statistical analyses were performed using the SPSS version 17. RESULTS: Perinea that required no suturing: MHG 71% (47) versus CG 56% (37), OR: 1.803; (95% CI: 0.881-3.687); DHG 62% (41) versus CG 56% (37), OR:1.285 (95% CI: 0.641-2.577); MHG 71% (47) versus DHG 62% (41), OR:1.402 (95% CI: 0.680-2.890). MEAN: Apgar score 5', MHG: 9.91; DHG: 9.98, CG: 9.98. p=0.431. CONCLUSIONS: The application of heat therapy to the perineum during labour did not significantly reduce perineal suturing after birth. However, better perineal results were observed with moist heat. Heat therapy does not alter neonatal outcomes measured by Apgar score.

[CONTROL OF FETAL WELL-BEING: BIOPHYSICS ANTEPARTUM MONITORING]. / Control del bienestar fetal. Monitorización biofísica anteparto.

This article provides an update on the control of antepartum fetal well-being, including the biophysical monitoring with non-stressful and stressful test and its evaluation. The fetal heart rate--base line, variability and transitional increases in fetal heart rate--are described based on fetal movements, its clinical meaning and actions derived from it.