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

Lal, Mira (2012)
Ph.D. thesis, University of Birmingham.

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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:Ph.D. thesis.
Supervisor(s):Holder, Roger and Oyebode, Femi and Morton, Dion
School/Faculty:Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:School of Medicine
Subjects:BF Psychology
HA Statistics
HQ The family. Marriage. Woman
HV Social pathology. Social and public welfare
RA Public aspects of medicine
RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
RG Gynecology and obstetrics
Institution:University of Birmingham
Copyright Holders:Mira Lal
ID Code:3729
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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