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Obstetric Trauma (obstetric + trauma)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Anorectal three-dimensional endosonography and anal manometry in assessing anterior rectocele in women: a new pathogenesis concept and the basic surgical principle

COLORECTAL DISEASE, Issue 1 2007
F. S. P. Regadas
Abstract Objective, The anatomy of the anal canal, the anorectal junction and the lower rectum was studied with 3-D ultrasound. Method, Seventeen women with normal bowel transit, without rectocele (group 1) and 17 female patients with a large anterior rectocele (group 2) were examined with a B&K Medical Rawk®. Mean age was 44.5 and 51.6 years respectively. In group 1, one (5.8%) patient was nuliparous, five (29.4%) had a caesarian section, 11 (64.7%) had a vaginal delivery while in group 2, two (11.7%) patients were nuliparous, four (23.5%) had a caesarian section and 11 (64.7%) had a vaginal delivery. Images were reconstructed in midline longitudinal (ML) and transverse (T) planes. The external (EAS) and internal (IAS) anal sphincters were measured in both projections. Results, In the ML plane, the EAS length was longer in group 1 (1.94 cm vs 1.61 cm, P < 0.05), the gap length was shorter (1.54 cm vs 1.0 cm P < 0.01) and the wall thickness was shorter in group 2 (0.40 cm vs 0.50 cm P < 0.01). The IAS (0.18 cm vs 0.23 cm P < 0.01) and EAS thickness (0.68 cm vs 0.77 cm, P < 0.05) (left lateral of the posterior quadrant) was greater in group 2. In group 1, the anterior upper anal canal wall in normal females was an extension of the rectal wall and the circular muscle was thicker in the mid-anal canal to form the IAS. In group 2, however, the wall layers were not identified and the IAS was found to be more distal. The differences were not statistically significant in the anal canal resting and squeeze pressures in the two groups. Conclusion, Obstetric trauma does not seem to play any role in rectocele pathogenesis because the anal sphincter muscles are anatomically and functionally normal and rectocele is also present in nuliparous and in women with caesarian sections. It seems that it is associated with the absence of EAS and thinner IAS in the anterior upper anal canal. Herniation starts at the upper anal canal extending to the lower rectum in high or large rectoceles and maybe produced by rectal intussusception because of excessive and prolonged straining during defecation. In fact, the denomination ,rectocele' should be changed to ,anorectocele'. [source]

Does a change in obstetric management influence the incidence of traumatic birth lesions in mature, otherwise healthy newborn infants?

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2007
Willibald Zeck
Abstract Aim:, The incidence of lesions due to birth trauma can be generally regarded as a characteristic of obstetric management; since obstetric management has changed through the years, one might expect a decrease or increase of lesions due to birth trauma in mature newborn infants. Methods:, In a retrospective study, the incidence of lesions due to birth trauma was recorded in the year 2000. In 1989, an identical study had already been carried out in the same department, employing the same criteria. The new findings were compared with the historical data. Results:, In the year 1989 24.6% and in 2000 13.2% showed lesions due to obstetric trauma. The episiotomy rate and lesions due to birth trauma had significantly decreased. A decline regarding the traumas per se was noticed in caput succedaneum traumas, in hematomas due to birth trauma and in clavicle fracture. The cesarean section rate among the study group increased. The cesarean section rate among the traumatized newborns decreased. Conclusion:, Episiotomy does not prevent newborns from traumatic lesions. Gestational age and birthweight have not significantly changed throughout the years; therefore an increase in the cesarean section rate must have contributed to the decrease of birth traumas. Even during abdominal operative delivery, obstetric traumas in newborns do occur. However, an increase in cesarean sections alone can not thoroughly explain the reduction of birth lesion among newborns. Improvement in prenatal diagnostic tools and procedures, respectively, and a goal-oriented use of labor induction might also play a major role. [source]

Factors Related to Genital Tract Trauma in Normal Spontaneous Vaginal Births

BIRTH, Issue 2 2006
Leah L. Albers CNM
In settings with very low rates, evidence remains sparse on how best to facilitate birth without lacerations. The purpose of this investigation was to identify maternal and clinical factors related to genital tract trauma in normal, spontaneous vaginal births. Methods:Data from a randomized clinical trial of perineal management techniques were used to address the study objective. Healthy women had spontaneous births with certified nurse-midwives in a medical center setting. Proportions of maternal characteristics and intrapartum variables were compared in women who did and did not sustain sufficient trauma to warrant suturing, according to parity (first vaginal births versus others). Logistic regression using a backward elimination strategy was used to identify predictors of obstetric trauma. Results: In women who had a first vaginal birth, risk factors for trauma were maternal education of high school or beyond, Valsalva pushing, and infant birthweight. Risk factors in women having a second or higher vaginal birth were prior sutured trauma and infant birthweight. For all mothers, delivery of the infant's head between contractions was associated with reduced trauma to the genital tract. Conclusions:Delivery technique that is unrushed and controlled may help reduce obstetric trauma in normal, spontaneous vaginal births. (BIRTH 33:2 June 2006) [source]