Immediate postpartum perineal examination as a predictor of puerperal pelvic floor dysfunction.
OBJECTIVE
To determine the relation between postpartum perineal trauma and the development of puerperal pelvic floor dysfunctions.


METHODS
A prospective study was conducted on 218 primiparae immediately after vaginal delivery. Women were divided in three groups according to perineal trauma: group A (n = 171) intact perineum or superficial tear, group B (n = 39) perineal muscle tears, group C (n = 8) anal sphincter tears with or without disruption of the rectal mucosa. Two months later, each woman was questioned about urogynecologic symptoms and examined by digital test, vaginal perineometry, and uroflowmetric stop test score.


RESULTS
No significant difference was found among the groups with regard to the incidence of stress incontinence, frequency/urgency, and urge incontinence, whereas anal incontinence was found more commonly in group C (group C versus group A: P =.003, odds ratio 18.78). No significant difference was found for digital test, perineometry, and uroflowmetric stop test.


CONCLUSIONS
Immediate postpartum perineal examination is not a good predictor of stress incontinence and pelvic floor weakness but could identify women at risk for anal dysfunctions: intact perineum does not exclude the appearance of symptoms related to perineal trauma after vaginal delivery.
Pregazzi
Roberto
R
Department of Obstetrics and Gynecology, Burlo Garofolo, University of Trieste, Trieste, Italy.
Sartore
Andrea
A
Bortoli
Paolo
P
Grimaldi
Eva
E
Ricci
Giuseppe
G
Guaschino
Secondo
S
D000328:Adult; D005242:Fecal Incontinence / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D018482:Muscle, Skeletal / Q000293:injuries*; D010298:Parity; D017773:Pelvic Floor; D010502:Perineum / Q000293:injuries*; D010808:Physical Examination / Q000009:adverse effects*; D049590:Postpartum Period; D011446:Prospective Studies; D014549:Urinary Incontinence / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D014563:Urodynamics