Short summary

Perineal wound infection is a complication of perineal trauma during vaginal delivery. There is limited information available on the rates of perineal wound infection, with a wide variation in prevalence statistics, and the subsequent risk of developing long-term maternal morbidity. The aim of this study is to determine the prevalence and risk factors of perineal wound infection and wound separation among women who have sustained a perineal tear, and to evaluate how wound infection may be associated long-term morbidity.

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Rationale

More than 80% of primparous women and up to 50% of multiparous women sustain a perineal tear after vaginal delivery. Laceration of the vagina and perineum during vaginal delivery are classified as first-, second-, third- and fourth-degree. Short-term maternal morbidity after a perineal tear is related to problems with wound infection and healing. The most frequent long-term indicators of maternal morbidity are anal incontinence (AI), urinary incontinence (UI) and dyspareunia. Little evidence is available regarding wound infection among women who have sustained a perineal tear and the influence of developing long-term maternal morbidity.

Peripartum injury can have a detrimental impact on the women's short- and long-term health resulting in social exclusion, loss of self-confidence and diminishes the ability to enjoy the experience of motherhood. There is a critical need for further research on this neglected area of aftercare during the puerperium, with an aim to minimize morbidity. The goal of this study is to determine the prevalence and risk factors of perineal wound infection and wound separation among women who have sustained a perineal tear, and to evaluate how wound infection may be associated with AI, UI, and dyspareunia.

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Description of the cohort

The study will be conducted at Odense University Hospital, Esbjerg Hospital and Kolding Hospital among primiparous and multiparous women with first-fourth degree perineal tears.

Data and biological material

Women who accept participation will undergo a physical examination 2 and 52 weeks postpartum with wound culture (the presence of aerobe and anaerobe microbes will be analyzed), blood samples (leucocyte count, neutrofilocyte count and a C-reactive protein), endoanal ultrasound (EAU) and anal manometry in order to assess wound infection, healing, AI, UI and dyspareunia. The women will be asked to fill in a set of standardized and validated questionnaires during the clinical controls 2 and 52 weeks postpartum. Biospecimens are not stored, and will be disposed according to standards procedures of the Department of Micobiology and the Department of Clinical Biochemistry after analysis.

Collaborating researchers and departments

Department of Gynaecology and Obstetrics ,Odense University Hospital

• PhD-student Henrik Christian Drue, MD

Department of Gastroenterological Surgery, Odense University Hospital

• Professor and Senior Consultant Niels Qvist

Department of Gynaecology and Obstetrics, Kolding Hospital (Hospital Lillebaelt)

• Consultant Annemette W. Lykkebo

Department of Gynaecology and Obstetrics, Hospital SouthWest Jutland, Esbjerg

• Staff Specialist Mette H. Ibsen

OPEN Odense Patient data Explorative Network, Odense University Hospital