title: Perineal outcome and the risk of pelvic floor dysfunction: a cohort study of primiparous women.
abstract: BACKGROUND
  Pelvic floor dysfunction (PFD) is the most common complication of childbirth. Assumptions have been made that perineal trauma increases the risk of PFD compared to an intact perineum, however the evidence for this is lacking. The aim of this study was to explore the relationship between perineal outcome and postpartum PFD.
  
  
  METHODS
  Prospective cohort study design, with a self-reported quality of life (QOL) questionnaire mailed to all primiparous women with a non-instrumental delivery at The Townsville Hospital between 2011 and 2012 (n = 766). ANOVA was used to compare how the symptoms of PFD affect QOL in women with an intact perineum, episiotomy or spontaneous tear.
  
  
  RESULTS
  Seventy-nine percent of the population had perineal injury; 60% had a spontaneous tear and 19% had an episiotomy. Ninety-seven percent of women who completed the questionnaire (n = 196) complained of PFD symptoms. Women with episiotomy had the best QOL, reporting the lowest levels of urinary dysfunction (statistically significant). No differences between the groups were found for symptoms of bowel, prolapse or sexual dysfunction.
  
  
  CONCLUSIONS
  This study shows a relationship between perineal outcome and PFD and suggests that an episiotomy is associated with the least morbidity due to symptoms of urinary incontinence. Additional large-scale prospective research is required to further investigate and delineate the impact of childbirth on PFD.
authors.affiliation: Department of Obstetrics and Gynaecology, James Cook University, Townsville, Queensland, Australia.
authors.forename: Joan
authors.initials: J
authors.lastname: Rikard-Bell
authors.forename: Jay
authors.initials: J
authors.lastname: Iyer
authors.forename: Ajay
authors.initials: A
authors.lastname: Rane
mesh_terms: D000293:Adolescent; D000328:Adult; D004841:Episiotomy; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D022125:Lacerations / Q000150:complications*; D007744:Obstetric Labor Complications; D010298:Parity; D036801:Parturition; D059952:Pelvic Floor Disorders / Q000209:etiology*; D056887:Pelvic Organ Prolapse / Q000209:etiology; D010502:Perineum / Q000293:injuries* / Q000601:surgery*; D011247:Pregnancy; D011446:Prospective Studies; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D011795:Surveys and Questionnaires; D015599:Trauma Severity Indices; D014550:Urinary Incontinence, Stress / Q000209:etiology*; D055815:Young Adult
keywords: episiotomy; incontinence; pelvic floor; perineum; quality of life