Risløkken Jeanette, Dalevoll Macedo Marthe, Bø Kari, Ellström Engh Marie, Siafarikas Franziska
University of Oslo, Faculty of Medicine, Division Akershus University Hospital, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway.
University of Oslo, Faculty of Medicine, Division Akershus University Hospital, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway.
Midwifery. 2024 Apr;131:103930. doi: 10.1016/j.midw.2024.103930. Epub 2024 Jan 23.
Second-degree perineal tears are common and can vary widely in the extent of tissue trauma. Therefore, a better understanding of perineal pain based on tissue trauma severity in second-degree tears is needed.
The primary aim of this study was to assess differences in perineal pain according to the severity of perineal tears, with a focus on subcategories of second-degree tears, during the first three months postpartum. The secondary aim was to assess the use of pain medication and breastfeeding patterns according to the severity of the second-degree tears.
In this observational cohort study, nulli- and multiparous women with singleton pregnancies were included during pregnancy. After birth, perineal tears were classified using the latest international classification system. In addition, second-degree tears were subcategorised according to percentage of damage to the perineum (<50 %=2A,>50 % but less than entire perineum=2B, affecting entire perineum, anal sphincter not involved=2C). Perineal pain, use of pain medication and breastfeeding patterns were assessed during a phone interview seven to ten days postpartum and through an electronic questionnaire three months postpartum.
Out of 880 vaginal births, 852 participants completed the phone interview and 715 answered the electronic questionnaire. During the first three months postpartum, women with 2C-tears reported statistically significantly higher pain scores and more frequent use of pain medication compared to women with 2A-tears. There was no statistically significant difference between the number of participants not breastfeeding between second-degree tear subcategories.
Women with 2C-tears reported higher perineal pain scores and more use of pain medication compared to those with less severe tears during three months postpartum.
二度会阴撕裂很常见，组织创伤程度差异很大。因此，需要更好地了解基于二度撕裂组织创伤严重程度的会阴疼痛情况。
本研究的主要目的是评估产后前三个月会阴疼痛根据会阴撕裂严重程度的差异，重点关注二度撕裂的亚类。次要目的是根据二度撕裂的严重程度评估止痛药物的使用情况和母乳喂养模式。
在这项观察性队列研究中，纳入孕期单胎妊娠的初产妇和经产妇。产后，使用最新的国际分类系统对会阴撕裂进行分类。此外，二度撕裂根据会阴损伤百分比进行亚分类（<50% = 2A，>50%但小于整个会阴 = 2B，累及整个会阴，未累及肛门括约肌 = 2C）。在产后7至10天通过电话访谈以及产后3个月通过电子问卷评估会阴疼痛、止痛药物使用情况和母乳喂养模式。
在880例阴道分娩中，852名参与者完成了电话访谈，715人回答了电子问卷。在产后前三个月，与2A类撕裂的女性相比，2C类撕裂的女性报告的疼痛评分在统计学上显著更高，且使用止痛药物更频繁。二度撕裂亚类之间未母乳喂养的参与者数量没有统计学上的显著差异。
与产后三个月内撕裂程度较轻的女性相比，2C类撕裂的女性报告的会阴疼痛评分更高，使用止痛药物更多。
