Perinea! trauma is defined as damage that occurs to the perineum during childbirth that can be unintentional or iptentional. Lacerations can range from first degree, which involves only injury to the skin, to fourth degree which involves injury to underlying structures· and the anus. An episiotomy, a cut made to the perineum, is considered trauma as well. One of the common concerns of women about childbirth is suffering some form of perineal trauma. Perineal trauma can lead to many complications such as pain, infections, increased bleeding, and incontinence. There are many interventions that can decrease a woman's chances of sustaining damage to the perineum whether unintentional or intentional. This integrated literature review explores research that has been performed to examine the different types of interventions and their success at preventing perineal trauma from 1997 to 2008. Perineal Massage, obstetric gel, warm compress, hands off method, oils and lubricants, birthing positions, using hyaluronidase, avoidance of Valsalva pushing, not using augmentation, not using episiotomies, and using a Midwife were examined. All interventions showed a decreased amount of perineal trauma during childbirth, however, some were more effective than others. By using evidence-based interventions, practitioners can decrease the occurrence and severity of perineal trauma, and make the child birthing process have more positive outcomes.

Yes / Perineal trauma is associated with short- and long-term maternal morbidity. Research has found that maternal position at birth can influence perineal trauma. However, there is a dearth of evidence examining specific maternal positions, including waterbirth, and how these can influence incidence and degree of perineal trauma. Such evidence is important to help reduce trauma rates and improve information for women and midwives. To address this gap in reliable evidence, a systematic review was conducted. Seven studies met the inclusion criteria. Compared to land birth, waterbirth was found to cause an increase in perineal trauma. Kneeling and all-fours positions were most protective of an intact perineum. Allowing for different variables, sitting, squatting and using a birth-stool caused the greatest incidence of trauma. The findings of this review demonstrate that further research is required around perineal guarding in alternative birth positions and how parity affects trauma rates with waterbirth, so that women may be advised appropriately. It also suggests findings that midwives can use when discussing alternative birth positions with women.

BACKGROUND: Among childbirth injuries the most common described symptoms are urine and faecal incontinence, pain during intercourse and perineal pain after rupture and suture. For those women who seek care for lasting nuisance are the routines for follow-up, diagnoses and treatment of childbirth injuries experience insufficient. AIM: The aim of this study was to illuminate women’s experience after of a childbirth injury and encounter the healthcare.  METHOD: A litterateur review based on six articles with qualitative data.  RESULT: Two categories with five subcategories are presented; To live with a childbirth injury- physical and emotional limitations of everyday life, normalization of injuries after childbirth and Encounter the healthcare- insufficient information and follow-up, encounter from the healthcare.  CONCLUSIONS: Women normalize their difficulties today after childbirth causing them not to seek help. The stigma surrounding the nuisance is also a contributing factor for women to contact the health care. Furthermore they experience to get dismissed by the healthcare professionals and not been taken seriously. Caregivers should inform the women about the concerning nuisance that can occur and give information where to seek help. / BAKGRUND: Bland förlossningsskador är de vanligaste beskrivna symtomen urin- och fekalinkontinens, smärta under samlag och mellangårdssmärta efter bristningar och suturer. För dom kvinnor som söker vård för långvariga besvär är rutinerna  för uppföljning, utredning och behandling av förlossningsskador bristfällig. SYFTE: Syftet med studien var att belysa kvinnors upplevelser av en förlossningsskada och mötet med vården.  METOD: En allmän litteraturöversikt baserat på sex artiklar med kvalitativa data.  RESULTAT: Två kategorier och fem underkategorier presenteras; Att leva med förlossningsskador- fysiska och emotionella begränsningar i vardagen, normalisering av förlossningsskador och Möte med vården- bristande information och uppföljning, bemötandet från vården.  SLUTSATSER: Kvinnor normaliserar idag sina besvär efter en förlossning vilket medför att de inte söker hjälp. Stigmat kring besvären är också en bidragande faktor till att kvinnor undviker att kontakta vården. De upplever också sig som avfärdade av vårdpersonal och en känsla om att inte bli tagna på allvar. Vårdpersonal bör informera kvinnorna om de berörda besvären som kan uppkomma och ge information var de kan söka hjälp.

Severe perineal trauma with injury to the anal sphincter at childbirth can have a profound effect on the physical and psychological wellbeing of women. This thesis describes literature examining resulting outcomes including effects on body image. It describes patient-based outcome measures used to capture this information, and evaluation of their psychometric properties. Body Image can be defined as an individual's perceptions and feelings about their own body. There is a growing interest in how this concept can influence quality of life and psychosocial dysfunction in medical disorders. This thesis aimed to examine relationships between severity of perineal trauma, general and genital specific body image and potentially influences such as symptoms of pelvic floor dysfunction. No patient-reported outcome measure validated for use in women after anal sphincter injury exists and this thesis also aimed to psychometrically evaluate an existing electronic questionnaire, ePAQ (electronic personal assessment questionnaire), for this application. In the thesis, a retrospective review of body image and physical outcomes attending a perineal clinic shows over half of women report perceived changes in body image after anal sphincter injury, with negative effects on self-esteem. A prospective observational cohort study explored genital and general body image in primiparous women grouped according to degree of perineal trauma or caesarean delivery. Women completed the Female Genital Self Image Score, the modified Body Image Score, ePAQ and the Edinburgh Postnatal Depression Scale a mean of 15.5 weeks (standard deviation 1.6) after delivery. There were significant differences in genital body image scores between the groups, but not in general body image, with regression analysis showing the greatest influence on genital body image to be the anatomical extent of the trauma. Embedded into this study was the evaluation of reliability (internal consistency and test-retest) and validity (face, content and construct) of ePAQ in the group of women with anal sphincter tears. This thesis presents the first research to quantify issues surrounding severe perineal trauma and body image and demonstrates that more severe trauma leads to a poorer genital body image. It also reports psychometric evaluation of ePAQ in women after anal sphincter injury providing the first single instrument with validity and reliability for use in this context.

Av de kvinnor som genomgår vaginalförlossning drabbas 85% av förlossningsbristningar, och följderna av dessa kan variera från lätta besvär till svåra komplikationer. En förutsättning för att kvinnan ska få rätt behandling är en korrekt diagnostik. Majoriteten av bristningarna handläggs av barnmorskor, och tidigare forskning har visat att kunskapen och kompetensen inom området varierar. Studiens syfte var att kartlägga svårigheter i barnmorskors arbete med att undersöka och bedöma vaginalbristningar efter förlossning. En enkätundersökning med barnmorskor som handlagt 72 förlossningar på en mellanstor förlossningsklinik vid ett svenskt sjukhus genomfördes under en period av 7 veckor. Resultatet visade att de vanligaste hindren vid granskning av bristningar var blödning och smärta hos patienten och de vanligaste svårigheterna var att identifiera strukturer och vävnader i bristningen. I en fjärdedel av fallen tog handläggande barnmorska stöd av kollega eller läkare, och några barnmorskor skattade sin kunskap och kompetens inom området som otillräcklig. Behovet av kollegialt stöd och av fortbildning och träning uttrycktes hos barnmorskor med både kort och lång erfarenhet. Det finns ett behov av fortsatt forskning om blödning som hinder för bedömning av förlossningsbristningar och av utvärdering av smärtlindringsmetoder. / Of all women undergoing vaginal birth, 85% sustain some form of perineal trauma and the consequences vary from smaller problems to severe complications. An accurate diagnosis of the trauma is necessary for it to be adequately treated. A majority of the perineal and vaginal ruptures are managed by midwives, and earlier research has shown that there is a considerable variation in midwives knowledge and skills concerning perineal trauma. The aim of this study was to explore difficulties in midwives examinations and assessments of perineal trauma following vaginal birth. A survey with midwives attending 72 births within a medium- sized Swedish birth-clinic, was conducted in a period of 7 weeks. The most common obstacles in assessing perineal ruptures, were the patient ́s bleeding and pain. The largest difficulties in assessment were identifying the structures and anatomy within the rupture. In one case out of four, peer support from midwife colleague or doctor was sought, and there were cases of midwives estimating their competence as non-sufficient. The need for peer support and continuous training and education was expressed in cases with midwives having short and long experience. There is a need for further research in the focus on bleeding as an obstacle in assessment of perineal trauma, and a need for further evaluation of the anaestethical methods used in management of them.

Objective Our aim was to compare two regimens of antibiotic prophylaxis at the time of repair of obstetric anal sphincter injury. Benefit of long regimen of antibiotic prophylaxis in comparison with short regimen of antibiotic administration haven't been till now proven. Material and Methods Women who gave vaginal birth in department of gynaecology and obstetrics of the First Faculty of Medicine of Charles University and Hospital Bulovka from 1.1.2008 to 30.6.2013 and who sustained third - or fourth - degree perineal tears have been enrolled in our trial. All women who fulfilled trial criteria received at the time of repair antibiotic prophylaxis which was cefuroxim (second - generation cephalosporin). This antibiotic has good sensitivity to vaginal gram-positive flora and to rectal gram-negative microorganisms too. Suture technique and following postpartum care have been standardized. All enrolled women were checked 2 weeks and 3 months after delivery. We evaluated subjective and objective parameters of healing of the obstetric perineal injury and 3 months postpartum we looked for symptomps regarding anal incontinence. The Manchester questionnaire was used for evaluation of anal incontince occurance. Results Incidence of third - and fourth - degree perineal tears was 1,4 % during period of our...

Objective Our aim was to compare two regimens of antibiotic prophylaxis at the time of repair of obstetric anal sphincter injury. Benefit of long regimen of antibiotic prophylaxis in comparison with short regimen of antibiotic administration haven't been till now proven. Material and Methods Women who gave vaginal birth in department of gynaecology and obstetrics of the First Faculty of Medicine of Charles University and Hospital Bulovka from 1.1.2008 to 30.6.2013 and who sustained third - or fourth - degree perineal tears have been enrolled in our trial. All women who fulfilled trial criteria received at the time of repair antibiotic prophylaxis which was cefuroxim (second - generation cephalosporin). This antibiotic has good sensitivity to vaginal gram-positive flora and to rectal gram-negative microorganisms too. Suture technique and following postpartum care have been standardized. All enrolled women were checked 2 weeks and 3 months after delivery. We evaluated subjective and objective parameters of healing of the obstetric perineal injury and 3 months postpartum we looked for symptomps regarding anal incontinence. The Manchester questionnaire was used for evaluation of anal incontince occurance. Results Incidence of third - and fourth - degree perineal tears was 1,4 % during period of our...