Clinical Review

Managing perineal trauma after childbirth

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6829 (Published 26 November 2014) Cite this as: BMJ 2014;349:g6829
  1. Sara Webb, specialist perineal midwife1,
  2. Margaret Sherburn, women’s health specialist physiotherapist23,
  3. Khaled M K Ismail, professor of obstetrics and gynaecology14
  1. 1Birmingham Women’s NHS Foundation Trust, Birmingham, UK
  2. 2Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Australia
  3. 3Royal Women’s Hospital, Melbourne, Australia
  4. 4Birmingham Centre for Women’s and Children’s Health, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, UK
  1. Correspondence to: K M K Ismail, Academic Unit, Birmingham Women’s NHS Foundation Trust, Birmingham B15 2TG, UK K.Ismail{at}bham.ac.uk

The bottom line

  • 85% of women will sustain perineal trauma after childbirth, and at least 70% of these will require suturing

  • Around 6% of affected women will experience important short term complications such as infection and wound dehiscence

  • Problems can extend into the long term, such as dyspareunia, urinary and faecal incontinence, pelvic organ prolapse, psychosocial problems, and postnatal depression

  • Timely assessment and repair of perineal trauma are necessary to ensure accurate repair

  • Women should be given help and advice about perineal care after the birth

  • Midwives, doctors, and health visitors caring for women in the postnatal period should ask appropriate questions and review the wound to ensure adequate healing

Every year millions of women worldwide sustain trauma to the perineum when giving birth. Around 6% of these women will have short term wound complications such as infection and dehiscence.1 Some are also at risk of long term problems such as dyspareunia, pain, urinary and faecal incontinence, pelvic organ prolapse, and psychosocial problems. Correct assessment and repair of this trauma is therefore essential to help reduce long term complications. In this review we focus on the management of childbirth related perineal trauma that does not involve injury to the anal sphincter complex (this has been dealt with previously2)—that is, first and second degree perineal trauma. We provide healthcare professionals caring for women during childbirth and the postnatal period with an overview of the current best evidence for the assessment, repair, and postnatal management of perineal trauma to reduce the incidence of complications in the short and long term.

Sources and selection criteria

We searched Medline and Embase from 1980 to date, limited to publications in English and to studies in women. Our search strategy used a combination of MeSH, textwords, and appropriate word variants of “perineal” or “trauma” and “obstetric” or “labour”. We supplemented these …

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