Do unsutured second-degree perineal lacerations affect postpartum functional outcomes?
BACKGROUND
To compare the postpartum pelvic floor function of women with sutured second-degree perineal lacerations, unsutured second-degree perineal lacerations, and intact perineums.


METHODS
A prospective cohort of nurse-midwifery patients consented to mapping of genital trauma at birth and an assessment of postpartum pelvic floor outcomes. Women completed validated questionnaires for perineal pain and urinary and anal incontinence at 12 weeks postpartum and underwent physical examination to assess pelvic floor strength and anatomy at 6 weeks postpartum.


RESULTS
One hundred seventy-two of 212 (80%) eligible women provided follow-up assessment data at 6 or 12 weeks postpartum. Women with an intact perineum (n=89) used fewer analgesics (P<.002) and had lower pain scores at the time of hospital discharge than women with second-degree lacerations (sutured, n=46; unsutured, n=37; intact, n=89) (P<or=.02). The sutured group was more likely to use analgesics (52%) than the unsutured (35%) or intact (23%) groups at time of hospital discharge (P<.002), although pain scores were not different between sutured and unsutured groups. Postpartum reports of urinary or anal incontinence, sexual inactivity, or sexual function scores did not vary between groups. Weak pelvic floor exercise strength was more common among the women with second-degree lacerations compared with women with an intact perineum (53% vs. 28%; P=.03) but did not differ between sutured (58%) and unsutured (47%) groups (P=not significant). Likewise, perineal body or genital hiatus measurements did not vary between groups (P=not significant).


CONCLUSIONS
Women with sutured lacerations report increased analgesic use at the time of hospital discharge compared with women with intact perineums or unsutured lacerations. At 12 weeks postpartum, no differences were noted between groups regarding complaints of urinary or anal incontinence, sexual inactivity, or sexual function.
Leeman
Lawrence M
LM
Department of Family and Community Medicine, School of Nursing, University of New Mexico Health Sciences Center, Albuquerque 87131, USA. lleeman@salud.unm.edu
Rogers
Rebecca G
RG
Greulich
Betsy
B
Albers
Leah L
LL
D000328:Adult; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D022125:Lacerations / Q000150:complications / Q000601:surgery / Q000628:therapy*; D008880:Midwifery; D007744:Obstetric Labor Complications / Q000601:surgery / Q000628:therapy*; D010146:Pain / Q000209:etiology; D017773:Pelvic Floor; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D013537:Sutures / Q000009:adverse effects; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology