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A Journal on Obstetrics and Gynecology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Minerva Ginecologica 2013 December;65(6):669-78
Assessment of postpartum perineal pain after vaginal delivery: prevalence, severity and determinants. A prospective observational study
Persico G. 1, Vergani P. 2, Cestaro C. 3, Grandolfo M. 4, Nespoli A. 5 ✉
1 Department of Surgery and Interdisciplinary Medicine University of Milano Bicocca, Monza, Italy;
2 Department of Surgery and Interdisciplinary Medicine University of Milano Bicocca, Monza, Italy;
3 Clinical Practice, San Gerardo Hospital Monza, Italy;
4 Epidemiologist, Istituto Superiore di Sanità Rome, Italy;
5 Department of Surgery and Interdisciplinary Medicine University of Milano Bicocca, Monza, Italy
Aim: Perineal pain is present, after birth, in almost all (95-100%) women who have experienced perineal trauma. It has been shown that women with spontaneous vaginal delivery and minimal or absent perineal trauma will have better recoveries: less pain, more tonic perineal muscles, improved sexual function and lower rates of depression. The purpose of the present study was to prospectively assess the prevalence of perineal pain in a population of women with vaginal birth at term and physiological single newborn.
Methods: Pain assessment was performed using two subjective scales: the Verbal Numeric Scale (VNS) of 11 points and the Verbal Rating Score (VRS) of 4 points. Data collection period ran from the first postnatal day until 6 months after delivery, with two intermediate measurements at 1 and 7 weeks after birth.
Results: The study enrolled 451 women: 239 primiparous and 212 multiparous, with a response rate of 92% at 6 months. The prevalence of pain was found 88.2% in the first day postpartum, 62.3% one week after birth, 8.0% at seven weeks and 0.7% at six months. With regard to the resumption of sexual activity at 6 months postpartum, a dyspareunia rate of 27% was observed in the Episiotomy group (OR 5.72, P<0.001).
Conclusion: The study found that an increase in the extent of trauma is associated with the highest scores in the self-assessment of perceived pain, with long term persistent symptoms. Furthermore, the presence of an episiotomy is a conditioning factor for the sexual function after childbirth (OR 0.43, P<0.001).