ContextEpisiotomy at the time of vaginal birth is common. Practice patterns
vary widely, as do professional opinions about maternal risks and benefits
associated with routine use.ObjectiveTo systematically review the best evidence available about maternal
outcomes of routine vs restrictive use of episiotomy.Evidence AcquisitionWe searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature,
and Cochrane Collaboration resources and performed a hand search for English-language
articles from 1950 to 2004. We included randomized controlled trials of routine
episiotomy or type of episiotomy that assessed outcomes in the first 3 postpartum
months, along with trials and prospective studies that assessed longer-term
outcomes. Twenty-six of 986 screened articles provided relevant data. We entered
data into abstraction forms and conducted a second review for accuracy. Each
article was also scored for research quality.Evidence SynthesisFair to good evidence from clinical trials suggests that immediate maternal
outcomes of routine episiotomy, including severity of perineal laceration,
pain, and pain medication use, are not better than those with restrictive
use. Evidence is insufficient to provide guidance on choice of midline vs
mediolateral episiotomy. Evidence regarding long-term sequelae is fair to
poor. Incontinence and pelvic floor outcomes have not been followed up into
the age range in which women are most likely to have sequelae. With this caveat,
relevant studies are consistent in demonstrating no benefit from episiotomy
for prevention of fecal and urinary incontinence or pelvic floor relaxation.
Likewise, no evidence suggests that episiotomy reduces impaired sexual function—pain
with intercourse was more common among women with episiotomy.ConclusionsEvidence does not support maternal benefits traditionally ascribed to
routine episiotomy. In fact, outcomes with episiotomy can be considered worse
since some proportion of women who would have had lesser injury instead had
a surgical incision.

https://jamanetwork.com/journals/jama/articlepdf/200799/jcr50003.pdf

Outcomes of routine episiotomy: a systematic review.

肛门直肠功能紊乱在消化科就诊患者中占有相当比例,其中包括各种器质性和功能性疾病.大便失禁属于排便功能紊乱的一种,是消化科医师常遇到的棘手问题,尤其在高龄患者、危重病人及截瘫病人中发病率居高不下[1].大便失禁可分为完全失禁和不完全失禁:大便完全失禁指不能随意控制粪便及气体的排出;而大便不完全失禁指可控制干便排出,却不能控制稀便和气体排出.疾病本身虽不能致命,却会带给患者难言的身心痛苦和生活不便,乃至造成人格变化,值得重视.但由于既往认识不足及诊断方法缺乏,迄今这些问题仍被忽视。

Fecal incontinence

Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy

The human body is colonized by a vast number of microorganisms collectively referred to as the human microbiota. One of the main microbiota body sites is the female genital tract, commonly dominated by Lactobacillus spp., in approximately 70% of women. Each individual species can constitute approximately 99% of the ribotypes observed in any individual woman. The most frequently isolated species are Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus jensenii and Lactobacillus iners. Residing at the port of entry of bacterial and viral pathogens, the vaginal Lactobacillus species can create a barrier against pathogen invasion since mainly products of their metabolism secreted in the cervicovaginal fluid can play an important role in the inhibition of bacterial and viral infections. Therefore, a Lactobacillus-dominated microbiota appears to be a good biomarker for a healthy vaginal ecosystem. This balance can be rapidly altered during processes such as menstruation, sexual activity, pregnancy and various infections. An abnormal vaginal microbiota is characterized by an increased diversity of microbial species, leading to a condition known as bacterial vaginosis. Information on the vaginal microbiota can be gathered from the analysis of cervicovaginal fluid, by using the Nugent scoring or the Amsel’s criteria, or at the molecular level by investigating the number and type of Lactobacillus species. However, when translating this to the clinical setting, it should be noted that the absence of a Lactobacillus-dominated microbiota does not appear to directly imply a diseased condition or dysbiosis. Nevertheless, the widely documented beneficial role of vaginal Lactobacillus species demonstrates the potential of data on the composition and activity of lactobacilli as biomarkers for vaginal health. The substantiation and further validation of such biomarkers will allow the design of better targeted probiotic strategies.

/pdf/lactobacillus-species-as-biomarkers-and-agents-that-can-4gbz40siab.pdf

Lactobacillus species as biomarkers and agents that can promote various aspects of vaginal health.

https://www.nejm.org/doi/pdf/10.1056/NEJM198612043152305

Andrea Sartore

Papers

The Effects of Mediolateral Episiotomy on Pelvic Floor Function After Vaginal Delivery

Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence

Lactobacillus plantarum P17630 for preventing Candida vaginitis recurrence: a retrospective comparative study.

First-trimester intrauterine hematoma and outcome of pregnancy

Postpartum urinary symptoms: prevalence and risk factors