Indications for surgical intervention in a postpartum pelvic floor specialty clinic
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ORIGINAL ARTICLE
Indications for surgical intervention in a postpartum pelvic floor specialty clinic Fatima Jibrel 1
&
Caroline K. Cox 1 & Pamela S. Fairchild 1 & Dee E. Fenner 1 & Shriya Suresh 1 & Carolyn W. Swenson 1
Received: 17 April 2020 / Accepted: 24 June 2020 # The International Urogynecological Association 2020
Abstract Objective To determine the prevalence and type of surgical procedures undergone by postpartum women seen in a specialty postpartum pelvic floor clinic over 11 years. Methods This study was a retrospective chart review of patients requiring surgical intervention within a 1-year period after their initial visit to the Michigan Healthy Healing After Delivery (MHHAD) clinic at the University of Michigan from July 2007 through January 2019. Chart review was performed to abstract demographics, obstetric data, indication for postpartum clinic visit, primary and secondary indications for surgery, and procedures performed. Descriptive analyses were used to describe the cohort. Results Of the 1138 new MHHAD patients seen during the study period, 9.1% (n = 103) underwent surgical management. Anal incontinence was the primary or secondary indication for surgery in 51.5% (n = 53) of women. The most common surgical interventions were anal sphincteroplasty (37.9%, n = 39), perineal laceration revision (33.0%, n = 34), and rectovaginal fistula repair/fistulotomy (19.4%, n = 20). Of the women who had a sphincteroplasty, 61.5% (24/39) had a prior fourth-degree perineal laceration. Conclusions Anal sphincteroplasty was the most common surgical intervention undergone by women seen in a postpartum pelvic floor specialty clinic. Postpartum pelvic floor clinics, such as the Michigan Healthy Healing After Delivery Clinic, provide the expertise and specialized resources required to ensure the early diagnosis and treatment of pelvic floor conditions related to childbirth thus improving women’s quality of life and preventing potential life-long sequelae. Keywords Obstetric anal sphincter injuries (OASIS) . Postpartum complications . Anal sphincteroplasty . Postpartum clinic
Introduction Pelvic floor disorders (PFDs) are common, and US women have a 20% lifetime risk of surgery for these conditions including pelvic organ prolapse, urinary, and fecal incontinence [1, 2]. While older women are often considered to be the group at highest risk for PFDs, these distressing conditions also affect postpartum women. The postpartum period, or “fourth trimester,” is an opportune time for early interventions that can help prevent PFDs from becoming lifelong morbidities.
* Fatima Jibrel [email protected] 1
University of Michigan Department of Obstetrics and Gynecology, L3211 Women’s Hospital, SPC 5276, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
The Michigan Healthy Healing after Delivery (MHHAD) clinic, established in 2007 at the University of Michigan (UM), was the first postpartum pelvic floor clinic in the US [3]. The goal of this subspecialty clinic is to address the unique pelvic floor needs of preg
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