Clinical Research On Delivery Without Perineum Protection Among Primiparas

Objective:To investigate the effects of Normal Vaginal Delivery without perineum protection among the full-term nulliparous women.Methods:Women giving birth in the department of gynecology and obstetrics at Zhongda Hospital Affiliated to Southeast University between September,2014 and November,2014, meeting the inclusion criteria were analyzed. The women were randomly divided into perineum protection group and episiotomy group. Records of gestational age, duration of labor, postpartum hemorrhage, birth weight, pregnancy BMI and newborn Apagar scores were taken; semi-quantitative scores were used to evaluate the pain status of postpartum perineal; post-natal care ability, the ability of newborn care, hand measuring of pelvic floor muscle strength and pelvic organ prolapse (Pelvic organ prolapse quantitive examination, POP-Q) scores were taken to evaluate maternal pelvic floor function; Sexual function of postpartum women was measured according to standard for evaluation of FSFI questionnaire. Statistial analysis was done with software of SPSS 16.0.Result:1. General Information:A total of 110 women were included in the study, afterseven people were lost,103 people were included in the final study,52 cases for perineum unprotected group and 51 cases for episiotomy group. There is no statistically significant between the two groups in maternal age, educational level, the number oftimes and miscarriage, gestational age, labor time, intra-partum postpartum hemorrhage, birth weight, pregnancy BMI, and other neonatal Apgar scores (P> 0.05);however, the closure time of perineal wound in unprotected group was less than thelateral group, the difference was statistically significant (P<0.05).2. Postpartum pain:Compared with unprotected labor group,1° pain ofepisio-tomy group patients was significantly increased at postpartum 24h and 48h,the difference was statistically significant (P<0.001); episiotomy and unprotected labor did not cause Ⅱ°-Ⅲ° pain.3. The self-care and newborn care ability:in perineum unprotected group, 21.1%mothers at the postpartum 24h could completely take care of themselves, comparedto 3.92% in episiotomy groups, the difference was statistically significant (P <0.001);and for postpartum newborn care ability, the rates of perineum unprotected group andepisiotomy group were 5.8% and 3.9%, respectively, the difference was notstatistically significant (P=0.132).4. Perineal damage:compared with episiotomy group, women of perineal unprotected group had significantly decreased perineal damage, the difference was statistically significant (P< 0.001).5. Postpartum pelvic floor:no statistical significance was found between the twogroups in postpartum urinary incontinence prevalence (P= 0.750); all mothers arepresent I or II degree of pelvic organs prolapse, the difference was not statisticallysignificant (P=0.324); there is no difference between the two groups in maternalpelvic floor muscle strength (P=0.631).6. Postpartum sexual function:compared with episiotomy group at 3 months ofpostpartum, women of perineal unprotected group had significantly increased sexualsatisfaction, decreased pain during intercourse (P<0.05); no statistical significancewas found between the two groups in sexual desire, arousal, vaginal lubrication andorgasm scores (P> 0.05); The results showed maternal sexual frequency was higherin perineal unprotected group than that in the lateral group, the difference wasstatistically significant (P=0.012).Conclusion:1.Compared with episiotomy group, unprotected natural childbirth techniquescan reduce postpartum short-term pain, reduce closure time of the perineal wound, help restore post-natal care ability and the ability of newborn care, does not increase the postpartum hemorrhage, without increasing asphyxia risk.2.Compared with the episiotomy group, unprotected delivery technology does notincrease the rate of postpartum urinary incontinence and pelvic organ prolapse risk;there was no significant difference in effects on the pelvic floor muscle strengthbetween the two groups.3.Compared with episiotomy group, women of perineal unprotected group hadsignificantly increased sexual satisfaction, decreased pain during intercourse.