Učinak lateralne epiziotomije na funkciju zdjeličnoga dna i seksualnu funkciju poslije vaginalnoga porođaja u prvorodilja [Effect of lateral episiotomy on the function of pelvic floor and sexual function after vaginal delivery in primiparas]

Živković, Krešimir (2018) Učinak lateralne epiziotomije na funkciju zdjeličnoga dna i seksualnu funkciju poslije vaginalnoga porođaja u prvorodilja [Effect of lateral episiotomy on the function of pelvic floor and sexual function after vaginal delivery in primiparas]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Episiotomy is an obstetrical procedure which extends the vaginal vestibule during fetal expulsion. Lateral episiotomy is widely used, but is rarely mentioned in the literature and its effect on the pelvic floor is unexplored. The available data largely support the theory of the negative or neutral effect of median and mediolateral episiotomy on the pelvic floor. The hypothesis of this study was that lateral episiotomy in primiparas has a protective effect on the emergence of urinary and anal incontinence, as well as sexual dysfunction during the first year postpartum. The aim of this study was to investigate the effect of lateral episiotomy on the pelvic floor in the primiparas in comparison to the group without episiotomy. Prospective study was conducted and consisted of 2 groups, with 100 examinees in each group. The first group consisted of women who had a delivery with lateral episiotomy and another group of women who had a delivery with perineal tears of I. and II. degree and intact perineum. The study included primiparas with singleton pregnancies and spontaneous onset of labor with fetuses in cephalic presentation. Examinations of pelvic floor were conducted at 5 and 8 months after delivery accompanied by specific questionnaires. International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form was used to assess urinary incontinence, while Wexner Scale was used to assess anal incontinence. Female Sexual Function Index was used to assess sexual function. The clinical examinations were consisted of: Pelvic Organ Prolapse Quantification system, cough stress test, transperineal sonography of anal sphincter and pelvic floor muscles and vaginal manometry. There were no significant differences in emergence of stress urinary incontinence between groups in two-time points (episiotomy: 16% and 13.5%; ruptures: 20% and 14.9%). There were also no differences in the occurrence of prolapse. Pelvic floor muscle strength was almost equal by groups as well as the occurrence of symptoms of anal incontinence and sexual dysfunction. There were certain relations between the ages of the examinees, oxytocin and weight of the newborn to poorer results of the questionnaires in episiotomy group. Obstetric and anthropometric variables were not associated with emergence of urinary and anal incontinence in episiotomy group. Our results indicate that the effect of lateral episiotomy on the pelvic floor is comparable to delivery with minimal perineal injuries. Rates of pelvic floor disorders as well as sexual dysfunction were similar by groups. No substantial associations between episiotomy and pelvic floor disorders have been found which is in accordance with majority of studies on other types of episiotomy. To conclude, lateral episiotomy has neither protective, nor negative effect on the onset of pelvic floor disorders and sexual dysfunction in the primiparas.

Abstract in Croatian

Epiziotomija je opstetriĉka operacija kojom se proširuje predvorje rodnice tijekom izgona ploda. Lateralna epiziotomija se ĉesto koristi, ali se rijetko spominje u literaturi te je njezin uĉinak na zdjeliĉno dno neistraţen. Dostupni podatci većinom idu u prilog teorije o negativnom ili neutralnom uĉinku medijalne i mediolateralne epiziotomije na zdjeliĉno dno. Hipoteza ovog istraţivanja je da lateralna epiziotomija u prvorodilja ima protektivan uĉinak na nastanak inkontinencije mokraće i stolice te seksualne disfunkcije tijekom prve godine poslije poroĊaja. Cilj ovog istraţivanja je bio istraţiti uĉinak lateralne epiziotomije na zdjeliĉno dno kod prvorodilja u usporedbi sa skupinom bez epiziotomije. Provedeno je prospektivno istraţivanje koje se sastojalo od 2 skupine sa 100 ispitanica u svakoj skupini. Prva skupina se sastojala od ţena koje su rodile uz lateralnu epiziotomiju, a druga skupina od ţena koje su rodile uz rupture meĊice I. i II. stupnja te uz intaktnu meĊicu. U studiju su se ukljuĉivale prvorodilje s jednoplodnim trudnoćama, spontanim poĉetkom poroĊaja te plodom u stavu glavicom. Kontrolni pregledi dna zdjelice su provedeni 5 i 8 mjeseci nakon poroda uz ispunjavanje specifiĉnih upitnika. International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form se koristio za procjenu urinarne inkontinencije, a Wexner ljestvica za procjenu analne inkontinencije. Female Sexual Function Index se koristio za procjenu seksualne funkcije. Kliniĉki pregled se sastojao od: Pelvic Organ Prolapse Quantification sustava, stres testa, transperinealne sonografije analnog sfinktera i mišićja dna zdjelice te vaginalne manometrije. Znaĉajne razlike u udjelima statiĉke inkontinencije mokraće izmeĊu skupinama u dvije vremenske toĉke nije bilo (epiziotomija: 16 % i 13,5 %; rupture: 20 % i 14,9 %). TakoĊer nije bilo razlike u pojavnosti prolapsa. Snaga mišićja zdjeliĉnog dna je bila pribliţno jednaka po skupinama kao i pojava simptoma analne inkontinencije te seksualne disfunkcije. Postojala je odreĊena povezanost dobi ispitanice, uporabe oksitocina, teţine novoroĊenĉeta na lošije ishode upitnika u skupini epiziotomije. Opstetriĉke i antropometrijske varijable nisu povećavale šansu za nastanak urinarne i analne inkontinencije u skupini epiziotomije. Naši rezultati ukazuju da je uĉinak lateralne epiziotomije na zdjeliĉno dno sliĉan uĉinku poroĊaja uz minimalne ozljede meĊice. Stope poremećaja zdjeliĉnog dna kao i seksualne disfunkcije su bile pribliţno jednake u obje skupine. Nisu naĊene znaĉajnije poveznice izmeĊu lateralne epiziotomije i poremećaja zdjeliĉnog dna što je u suglasju s većinom istraţivanja s drugim vrstama epiziotomije. Zakljuĉno se moţe reći da lateralna epiziotomija nema ni protektivan ni negativan uĉinak na pojavu disfunkcije zdjeliĉnog dna te seksualne disfunkcije u prvorodilja.

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