The goal of this observational study is to make us more aware of the short and long-term outcomes for women having an uncomplicated healing process after a rupture or birth cut in the perineum after giving birth in relation to a healing process with a dehisced wound treated with conservative management or secondary suturing. Participants will be asked to do * A gynecological examination at one month after birth and 9-12 months after birth. * Have a picture taken of the healing process * Answer a questionnaire at one month, three months, and 9-12 months after birth
The best way to manage perineal wound dehiscence after childbirth is unknown. Currently, there is no agreed best practice recommendation for managing perineal wound dehiscence due to a lack of evidence comparing conservative management with secondary suturing. Therefore, studies are urgently needed to compare the benefits and risks of both treatments. This study has the potential to significantly impact women´s health for those suffering from perineal wound dehiscence. The investigators want to include 100 women who have had a primary repair of a second-degree tear or episiotomy with a normal/uncomplicated healing process, 100 women with a second-degree tear or episiotomy identified with a dehisced wound treated with secondary resuturing, and 100 women with a second-degree tear or episiotomy identified with a dehisced wound treated with conservative management. All women who meet the inclusion criteria are recommended the same treatment and follow-up as currently present as standard care at the four hospitals that the investigators are recruiting from. The study deviates from the standard of care by offering two extra clinical examinations, one questionnaire evaluation without clinical examination, and a follow-up with pictures of the perineal tear healing process.
Study Type
OBSERVATIONAL
Enrollment
300
A clinical examination is needed to assess the healing process for the three groups. After assessing the healing process, we will take pictures of the tear for documentation.
The participant will answer questions, serving as a baseline questionnaire, when arriving at the clinical examination one month post-partum. At three and 9-12 months post-postpartum, they will receive another questionnaire. The questionnaire will consist of validated questions regarding body image, pain, Urogynecological problems as symptoms of prolapse, urinary and anal incontinence, and questions about sexual problems.
Department of Obstetrics and Gynaecology, Copenhagen University Hospital - Herlev and Gentofte
Herlev, Denmark
RECRUITINGBody image
Measured by the Body-Image questionnaire FGSIS - Female Genital Self-Image Scale
Time frame: 9-12 months
Wound healing
The proportion of women with healed wounds at one month post-partum assessed by clinical examination and REEDA scale (Redness, Oedema, Ecchymosis, Discharge, Approximation of the wound edges). The REEDA scale contains five criteria each receiving a score between 0 and 3. The total score range from 0 - 15 with lower scores representing better-wound healing
Time frame: One month
Infection rate
The proportion of women with an infected wound until one month post-partum assessed by clinical examination and measured by REEDA scale
Time frame: One month
Resuming sexual intercourse
Measured by the PISQ-12 questionnaire which is a short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)
Time frame: One month, three months, and 9-12 months
Dyspareunia
Measured by the PISQ-12 questionnaire which is a short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)
Time frame: One month, three months, and 9-12months
Woman´s satisfaction with the aesthetic results of the perineal wound
Self-reported. The woman will be asked if she is satisfied with the aesthetic results of the perineal wound
Time frame: One month, three months, and 9-12 months
Affected breastfeeding
The woman will be asked whether she is breastfeeding or not
Time frame: One month, three months, and 9-12 months
Re-admission
The women will be asked whether they have been readmitted to the hospital and why within four weeks p.p.
Time frame: Within one month
Prolapse
Measured by ICIQ-VS questionnaire which is a short form of the International Consultation on Incontinence Questionnaire - Vaginal Symptoms (ICIQ-VS)
Time frame: One month, three months, and 9-12 months
Urinary incontinence
Measured by the ICIQ-UI SF questionnaire which is a short form of the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF)
Time frame: One month, three months, and 9-12 months
Fecal incontinence
Measured by ICIQ-B questionnaire which is a short form of the International Consultation on Incontinence Questionnaire - Bowel (ICIQ-B)
Time frame: One month, three months, and 9-12 months
Psychological well-being (maternal anxiety or depression)
Measured by Edinburgh Postnatal Depression Scale (EPDS). EPDS is a self-assessment questionnaire consisting of ten statements and the respondent is asked about their feelings over the last seven days. The answers are scored from 0-3 which gives an endpoint from 0-30. In Denmark, women are said to have depressive symptoms after delivery if they score 11 or higher
Time frame: Three months, and 9-12 months
Pain intensity
Self-reported pain intensity measured by Visual Analog Scale (VAS-score). Numeric rating scale from 0-10 (0 = no pain - 10 = pain as bad as can be)
Time frame: One month, three months, and 9-12 months
Consuming painkillers because of pain due to perineal tear
The participant will be asked whether she is consuming painkillers because of pain due to a perineal tear (Yes/No)
Time frame: One month, three months, and 9-12 months
Pelvic floor muscle contraction
Measured by Modified Oxford scale
Time frame: One month and 9-12 months
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