One‐year follow‐up after standardized perineal reconstruction in women with deficient perineum after vaginal delivery

• Published in: Acta obstetricia et gynecologica Scandinavica 2023-10, Vol.102 (10), p.1338-1346
• Main Authors: Rotstein, Emilia, Ullemar, Vilhelmina, Engberg, Hedvig, Lindén Hirschberg, Angelica, Ajne, Gunilla, Tegerstedt, Gunilla
• Format: Article
• Language: English
• Subjects: Childbirth & labor; Clinical outcomes; deficient perineum; Gynecological surgery; levator ani muscle; Medicin och hälsovetenskap; Original; patient‐reported outcomes; pelvic floor dysfunction; Pelvic Pain and Surgery; Pelvis; perineal reconstruction; Reconstructive surgery; Surgical outcomes; surgical technique; Vagina
• ISSN: 0001-6349; 1600-0412; 1600-0412
• DOI: 10.1111/aogs.14666

Introduction Perineal tears are common after childbirth and, if not surgically repaired, they may result in a deficient perineum that can cause symptoms of pelvic floor dysfunction. Perineal reconstruction aims to restore the perineal body and increase the support of the pelvic floor. The objective of the present study was to estimate symptom reduction after perineal reconstruction in patients with deficient perineum after vaginal delivery and to compare outcomes between participants with or without concomitant levator ani muscle deficiency. Material and methods Participants presenting at the Karolinska Pelvic Floor Center with symptoms of deficient perineum at least 1 year after vaginal birth were invited to the study. Inclusion criteria were a visible perineal scar and confirmed anatomic defect. Levator ani defects were assessed using the Levator Ani Deficiency score. A perineal reconstruction was performed in a standardized way. Subjective symptoms were evaluated using the validated “Karolinska Symptoms After Perineal Tear Inventory” at baseline and 1‐year follow‐up. A score difference in the symptom of an acquired sensation of a wide vagina was the primary outcome. Results were stratified by the presence or absence of a levator ani deficiency. Results A perineal reconstruction was performed in 131 patients and 128 patients completed the Karolinska Symptoms After Perineal Tear Inventory at baseline and 119 at follow‐up. Median age was 36.1 (interquartile range [IQR] 7.9), median body mass index 22.3 (IQR 5.1) and a median of two vaginal deliveries. Fifty‐four women (41.2%) had a levator ani deficiency. The mean score reduction for the item “Do you feel that your vagina is too wide/loose?” was −1.56 (SD 0.96; P