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Title: Pelvic/perineal dysfunction & biopsychosocial morbidity : biological predictors and psychosocial associations in postcaesarean and vaginally delivered primiparae
Author: Lal, Mira
ISNI:       0000 0004 2729 597X
Awarding Body: University of Birmingham
Current Institution: University of Birmingham
Date of Award: 2012
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Background: The scope of postpartum pelvic dysfunction and perineal trauma is under-researched. Instrumental vaginal delivery or 3rd/4th degree tears were recognised risk factors for pelvic/perineal dysfunction; caesarean delivery was not implicated. Aims: • To analyse obstetrical/biological factors associated with pelvic dysfunction after caesarean or non-instrumental vaginal delivery • To compare these associations between groups after determining frequencies • To evaluate severity of pelvic/perineal dysfunction, including quantifying maternal perception of the psychosocial impact Participants and Methods: 284 primiparae (184 caesarean, 100 vaginally delivered) had domiciliary, in-depth medical interviews using structured and open questioning. Results: Caesarean (elective, emergency) vs. vaginally delivered were compared: Stress incontinence manifested in 60/184 (33%, 33%) vs. 54/100 (54%), anal incontinence in 94/184 (53%, 50%) vs. 44/100 (44%), dyspareunia in 50/184 (28%, 27%) vs. 46/100 (46%), haemorrhoids in 3/184 (2%) vs. 5/100 (5%) and double incontinence with dyspareunia in 33/284 (14%, 10% vs. 12%). Sixty sustained perineal trauma. Delivery mode and non-labour factors were predictors. Severity was evaluated by devising a psychosocial measure tailored to maternal functioning. New faecal incontinence necessitated continuous perineal protection in two pre-labour caesarean and one vaginally delivered mother. Severe dysphoria was associated with incontinence (p=0.038, OR 2.334, CI 1.049, 5.192), dyspareunia (p=0.005, OR 2.231, CI 1.272, 3.914) and post-caesarean wound problems (p=0.022, OR 3.620, CI 1.203, 10.896). Incontinence impaired leisure activities (p=0.036, OR 2.165, CI 1.051, 4.463) and employment (p=0.023, OR 1.912, CI 1.093, 3.345); caesarean mode affected social-networking (p=0.018, OR 2.438, CI 1.166, 5.099) and employment (p=0.031, OR 1.967, CI 1.064, 3.636). Conclusions: Pelvic/perineal dysfunction was: ▪ Predicted by caesarean or non-instrumental vaginal delivery, with anal incontinence being more prevalent post-caesarean ▪ Comparable following elective or emergency caesarean ▪ Associated with severe and quantifiable biopsychosocial maternal morbidity.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: BF Psychology ; HA Statistics ; HQ The family. Marriage. Woman ; HV Social pathology. Social and public welfare ; RA Public aspects of medicine ; RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry ; RG Gynecology and obstetrics