Pelvic/perineal dysfunction & biopsychosocial morbidity: biological predictors and psychosocial associations in postcaesarean and vaginally delivered primiparae

Lal, Mira (2012). Pelvic/perineal dysfunction & biopsychosocial morbidity: biological predictors and psychosocial associations in postcaesarean and vaginally delivered primiparae. University of Birmingham. Ph.D.

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Abstract

Background:
The scope of postpartum pelvic dysfunction and perineal trauma is under-researched. Instrumental vaginal delivery or 3rd/4th degree tears were recognised risk factors for pelvic/perineal dysfunction; caesarean delivery was not implicated.

Aims:
• To analyse obstetrical/biological factors associated with pelvic dysfunction after caesarean or non-instrumental vaginal delivery
• To compare these associations between groups after determining frequencies
• To evaluate severity of pelvic/perineal dysfunction, including quantifying maternal perception of the psychosocial impact

Participants and Methods:
284 primiparae (184 caesarean, 100 vaginally delivered) had domiciliary, in-depth medical interviews using structured and open questioning.

Results:
Caesarean (elective, emergency) vs. vaginally delivered were compared: Stress incontinence manifested in 60/184 (33%, 33%) vs. 54/100 (54%), anal incontinence in 94/184 (53%, 50%) vs. 44/100 (44%), dyspareunia in 50/184 (28%, 27%) vs. 46/100 (46%), haemorrhoids in 3/184 (2%) vs. 5/100 (5%) and double incontinence with dyspareunia in 33/284 (14%, 10% vs. 12%). Sixty sustained perineal trauma. Delivery mode and non-labour factors were predictors. Severity was evaluated by devising a psychosocial measure tailored to maternal functioning. New faecal incontinence necessitated continuous perineal protection in two pre-labour caesarean and one vaginally delivered mother. Severe dysphoria was associated with incontinence (p=0.038, OR 2.334, CI 1.049, 5.192), dyspareunia (p=0.005, OR 2.231, CI 1.272, 3.914) and post-caesarean wound problems (p=0.022, OR 3.620, CI 1.203, 10.896). Incontinence impaired leisure activities (p=0.036, OR 2.165, CI 1.051, 4.463) and employment (p=0.023, OR 1.912, CI 1.093, 3.345); caesarean mode affected social-networking (p=0.018, OR 2.438, CI 1.166, 5.099) and employment (p=0.031, OR 1.967, CI 1.064, 3.636).

Conclusions:
Pelvic/perineal dysfunction was:
▪ Predicted by caesarean or non-instrumental vaginal delivery, with anal incontinence being more prevalent post-caesarean
▪ Comparable following elective or emergency caesarean
▪ Associated with severe and quantifiable biopsychosocial maternal morbidity

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):