Search Results (3)

Background: Episiotomy-related morbidity remains a substantial challenge in postpartum recovery, often affecting maternal quality of life. Given the crucial role of local microbiota and wound environment in perineal healing, intravaginal lactic acid gel emerges as a promising adjunctive therapy. Objective: To evaluate the effectiveness and safety of intravaginal lactic acid gel (Canesbalance^®, Bayer) in enhancing scar healing and reducing pain following mediolateral episiotomy. Methods: In this single-center randomized controlled trial, 100 postpartum women with mediolateral episiotomy were allocated to either a treatment group receiving intravaginal lactic acid gel (Canesbalance^®, Bayer) or a standard care group. Scar healing was assessed at 7 and 40 days postpartum using POSAS, VAS, and NRS scores; hematological parameters were also monitored. Results: The lactic acid gel group demonstrated significantly greater reductions in scar severity and pain scores over time (p < 0.05), with no adverse hematological effects. Effect sizes (Cohen’s d) were moderate to high for scar healing (d = 0.76) and pain reduction (VAS: d = 0.83; NRS: d = 0.79), indicating clinical relevance beyond statistical significance. Conclusions: Intravaginal application of lactic acid gel may offer a safe and effective strategy to enhance perineal wound healing and pain relief after episiotomy. Further large-scale studies are warranted to validate these promising findings and explore underlying mechanisms. Full article

We present the case of a 36-year-old primigravida who gave birth to a 3200 g baby by vacuum-assisted (Kiwi OmniCup™) operative vaginal delivery with mediolateral episiotomy. A “y”-shaped perineal tear with a grade IIIC obstetric anal sphincter injury (OASI) was diagnosed and repaired. Two days after delivery, in the absence of suture dehiscence, she started experiencing complete anal incontinence. A decision was made in association with a proctologic surgeon for an early secondary repair. Before surgery, a Three-dimensional transperineal ultrasound (TPUS) was performed. The exam revealed a major defect of the external anal sphincter at the 11 o’clock position. This allowed for the reopening of only a circumscribed area of the perineal suture and repair of the sphincters using the end-to-end technique. The symptoms regressed completely, and follow-up TPUS demonstrated the gradual wound healing process. Anal incontinence, secondary to obstetric anal sphincter injury (OASI), has a severe negative impact on women’s quality of life. TPUS is an effective method to detect sphincter defects and monitor the healing process. This report investigates the feasibility of identifying the sphincter tear in an incontinent puerperal patient without suture dehiscence in order to target early secondary repair while minimizing its extent. TPUS has proven a safe and effective tool to guide early secondary repair of symptomatic OASI complications while minimizing the invasiveness of the procedure. Multidisciplinary management is crucial to ensure the adequate standard of care. Full article

Episiotomy is the surgical incision of the vaginal orifice and perineum to ease the passage of an infant’s head while crowning during vaginal delivery. Although episiotomy remains one of the most frequently performed surgeries around the world, short- and long-term complications from the procedure are not uncommon. We performed midline and mediolateral episiotomies with the aim of correlating commonly diagnosed postepisiotomy complications with risk of injury to perineal neuromuscular and erectile structures. We performed 61 incisions on 47 female cadavers and dissected around the incision site. Dissections revealed that midline incisions did not bisect any major neuromuscular structures, although they did increase the risk of direct and indirect injury to the subcutaneous portion of the external anal sphincter. Mediolateral incisions posed greater risk of iatrogenic injury to ipsilateral nerve, muscle, erectile, and gland tissues. Clinician discretion is advised when weighing the potential risks to maternal perineal anatomy during vaginal delivery when episiotomy is indicated. If episiotomy is warranted, an understanding of perineal anatomy may benefit diagnosis of postsurgical complications. Full article