Perineal evaluation in the puerperium. Role of testing with a cotton-tipped swab.
OBJECTIVE
To verify the applicability and significance of testing with a cotton-tipped swab in postpartum evaluation.


METHODS
One hundred seventy-eight puerperas were examined two months after vaginal delivery and underwent testing with a cotton-tipped swab, digital test, vaginal manometry and uroflowmetric urine stream interruption test. Statistical analysis was performed using Student's t test to evaluate the difference between mean values of continent and incontinent puerperas and the Bravais-Pearson coefficient to test the correlation between all the tests used in the study.


RESULTS
Incontinent puerperas and multiparas had significantly higher swab test values than did continent and primiparas, who demonstrated a swab test mean value of 39.5 degrees during the Valsalva maneuver. The sensitivity of the swab test for stress urinary incontinence was 82.5%, while its specificity and positive predictive value were, respectively, 31.1% and 25.8%.


CONCLUSIONS
Perineal damage occurs not only in symptomatic puerperas but most women. The swab test was unable to assess stress urinary incontinence in postpartum women, also, and demonstrated only urethral hypermobility. The swab test in the puerperium does not add significant information about pelvic floor performance and should not be used routinely postpartum.
Sartore
Andrea
A
Department of Obstetrics and Gynecology, Epidemiology Unit, Istituto di Ricerca e Cura a Carattere Scientifico Burlo Garofolo, University of Trieste, Via dell'Istria 65/1-34137 Trieste, Italy. sartore@burlo.trieste.it
Pregazzi
Roberto
R
Bortoli
Paolo
P
Grimaldi
Eva
E
Ricci
Giuseppe
G
Guaschino
Secondo
S
D000328:Adult; D032561:Cotton Fiber; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D017773:Pelvic Floor / Q000503:physiopathology*; D010502:Perineum / Q000293:injuries* / Q000503:physiopathology*; D049590:Postpartum Period; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D020127:Recovery of Function / Q000502:physiology; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D014636:Valsalva Maneuver