Skip to main content
SpringerLink
Log in

Healing Process and Complications

  • Chapter
  • First Online:
Childbirth Trauma

Abstract

The general healing cascade involves four interrelated and overlapping phases, which are haemostasis, inflammation, cellular and matrix proliferation and wound remodeling. Multiple factors, such as the extent of the trauma, surgical skills, suture technique, the type of suture material and poor maternal hygiene, can affect the magnitude and degree of the associated short- and long-term morbidity.

Complications of wound healing, including wound haematoma, infection, dehiscence, breakdown, labial fusion, introital narrowing, pain and dyspareunia, can be extremely distressing for the new mother.

Understanding the various factors associated with wound complications is critical in antepartum counseling of patients, as well as intrapartum and postpartum practices. Modification of these factors may be essential in avoiding short-term complications and preventing long-term consequences.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rogers RG, Leeman LM, Migliaccio L, Albers LL. Does the severity of spontaneous genital tract trauma affect postpartum pelvic floor function? Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):429–35. PubMed.

    Article  PubMed  Google Scholar 

  2. Robson MC, Steed DL, Franz MG. Wound healing: biologic features and approaches to maximize healing trajectories. Curr Probl Surg. 2001;38(2):72–140. PubMed Epub 2001/07/14. eng.

    Article  CAS  PubMed  Google Scholar 

  3. Diegelmann RF, Evans MC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci. 2004;9:283–9. PubMed.

    Article  CAS  PubMed  Google Scholar 

  4. Grabb WCPs, Smith JW, Aston SJ, et al. Chapter 2: Wound healing: Normal and Abnormal. In: Aston SJ, Beasley RW, Thorne CHM, editors. Grabb and Smith’s plastic surgery. 5th ed. Philadelphia: Lippincott-Raven; 1997.

    Google Scholar 

  5. Hardy MA. The biology of scar formation. Phys Ther. 1989;69(12):1014–24. PubMed.

    CAS  PubMed  Google Scholar 

  6. Vanwijck R. Surgical biology of wound healing. Bull Mem Acad R Med Belg. 2001;156(3-4):175–84; discussion 85. PubMed Biologie chirurgicale de la cicatrisation.

    CAS  PubMed  Google Scholar 

  7. Toumi H, Best TM. The inflammatory response: friend or enemy for muscle injury? Br J Sports Med. 2003;37(4):284–6. PubMed Pubmed Central PMCID: 1724680.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Bergmeier W, Hynes RO. Extracellular matrix proteins in hemostasis and thrombosis. Cold Spring Harb Perspect Biol. 2012;4(2):a005132. PubMed.

    Google Scholar 

  9. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26S–38. PubMed.

    Article  CAS  PubMed  Google Scholar 

  10. Stirling Y, Woolf L, North WR, Seghatchian MJ, Meade TW. Haemostasis in normal pregnancy. Thromb Haemost. 1984;52(2):176–82. PubMed.

    CAS  PubMed  Google Scholar 

  11. Gerbasi FR, Bottoms S, Farag A, Mammen E. Increased intravascular coagulation associated with pregnancy. Obstet Gynecol. 1990;75(3 Pt 1):385–9. PubMed.

    CAS  PubMed  Google Scholar 

  12. Challis JR, Lockwood CJ, Myatt L, Norman JE, Strauss 3rd JF, Petraglia F. Inflammation and pregnancy. Reprod Sci. 2009;16(2):206–15. PubMed.

    Article  CAS  PubMed  Google Scholar 

  13. Arnoczky SP, Tarvin GB, Marshall JL. Anterior cruciate ligament replacement using patellar tendon. An evaluation of graft revascularization in the dog. J Bone Joint Surg Am. 1982;64(2):217–24. PubMed.

    CAS  PubMed  Google Scholar 

  14. Chapter 9. Soft tissue damage and healing. http://www.iaaf.org/about-iaaf/documents/medical. Updated 23-10-2012; cited 2013.

  15. Falanga V, Grinnel F, Gilchrest B, Maddox YT, Moshell A. Experimental approaches to chronic wounds. Wound Repair Regen. 1995;3(2):132–40. PubMed.

    Article  CAS  PubMed  Google Scholar 

  16. Martin P. Wound healing – aiming for perfect skin regeneration. Science. 1997;276(5309):75–81. PubMed.

    Article  CAS  PubMed  Google Scholar 

  17. Stroncek JD, Reichert WM. Overview of wound healing in different tissue types. In: Reichert WM, editor. Indwelling neural implants: strategies for contending with the in vivo environment. Boca Raton: CRC Press; 2008.

    Google Scholar 

  18. Chamberlain CS, Leiferman EM, Frisch KE, Wang S, Yang X, van Rooijen N, et al. The influence of macrophage depletion on ligament healing. Connect Tissue Res. 2011;52(3):203–11. PubMed Pubmed Central PMCID: 3110150.

    Article  CAS  PubMed  Google Scholar 

  19. Broughton 2nd G, Janis JE, Attinger CE. Wound healing: an overview. Plast Reconstr Surg. 2006;117(7 Suppl):1e-S–32e-S. PubMed.

    Article  Google Scholar 

  20. Gulotta LV, Rodeo SA. Growth factors for rotator cuff repair. Clin Sports Med. 2009;28(1):13–23. PubMed.

    Article  PubMed  Google Scholar 

  21. Middleton KK, Barro V, Muller B, Terada S, Fu FH. Evaluation of the effects of platelet-rich plasma (PRP) therapy involved in the healing of sports-related soft tissue injuries. Iowa Orthop J. 2012;32:150–63. PubMed Pubmed Central PMCID: 3565396.

    PubMed  PubMed Central  Google Scholar 

  22. Valenzuela P, Saiz Puente MS, Valero JL, Azorín R, Ortega R, Guijarro R. Continuous versus interrupted sutures for repair of episiotomy or second-degree perineal tears: a randomised controlled trial. BJOG. 2009;116(3):436–41. PubMed.

    Article  CAS  PubMed  Google Scholar 

  23. Elharmeel SM, Chaudhary Y, Tan S, Scheermeyer E, Hanafy A, van Driel ML. Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention. Cochrane Database Syst Rev. 2011;(8):CD008534. PubMed.

    Google Scholar 

  24. Lundquist M, Olsson A, Nissen E, Norman M. Is it necessary to suture all lacerations after a vaginal delivery? Birth. 2000;27(2):79–85. PubMed.

    Article  CAS  PubMed  Google Scholar 

  25. Gennari R, Rotmensz N, Ballardini B, Scevola S, Perego E, Zanini V, et al. A prospective, randomized, controlled clinical trial of tissue adhesive (2-octylcyanoacrylate) versus standard wound closure in breast surgery. Surgery. 2004;136(3):593–9. PubMed.

    Article  CAS  PubMed  Google Scholar 

  26. Bernard L, Doyle J, Friedlander SF, Eichenfield LF, Gibbs NF, Cunningham BB. A prospective comparison of octyl cyanoacrylate tissue adhesive (dermabond) and suture for the closure of excisional wounds in children and adolescents. Arch Dermatol. 2001;137(9):1177–80. PubMed.

    Article  CAS  PubMed  Google Scholar 

  27. Matin SF. Prospective randomized trial of skin adhesive versus sutures for closure of 217 laparoscopic port-site incisions. J Am Coll Surg. 2003;196(6):845–53. PubMed.

    Article  PubMed  Google Scholar 

  28. Bhende S, Rothenburger S, Spangler DJ, Dito M. In vitro assessment of microbial barrier properties of Dermabond topical skin adhesive. Surg Infect (Larchmt). 2002;3(3):251–7. PubMed.

    Article  Google Scholar 

  29. Mota R, Costa F, Amaral A, Oliveira F, Santos CC, Ayres-De-Campos D. Skin adhesive versus subcuticular suture for perineal skin repair after episiotomy – a randomized controlled trial. Acta Obstet Gynecol Scand. 2009;88(6):660–6. PubMed.

    Article  PubMed  Google Scholar 

  30. Kettle C, Dowswell T, Ismail KM. Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears. Cochrane Database Syst Rev. 2012;(11):CD000947. PubMed.

    Google Scholar 

  31. Kindberg S, Stehouwer M, Hvidman L, Henriksen TB. Postpartum perineal repair performed by midwives: a randomised trial comparing two suture techniques leaving the skin unsutured. BJOG. 2008;115(4):472–9. PubMed.

    Article  CAS  PubMed  Google Scholar 

  32. Sultan AH, Thakar R. Lower genital tract and anal sphincter trauma. Best Pract Res Clin Obstet Gynaecol. 2002;16(1):99–115. PubMed.

    Article  PubMed  Google Scholar 

  33. Sultan AH, Monga AK, Kumar D, Stanton SL. Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol. 1999;106(4):318–23. PubMed.

    Article  CAS  PubMed  Google Scholar 

  34. Abramov Y, Feiner B, Rosen T, Bardichev M, Gutterman E, Lissak A, et al. Primary repair of advanced obstetric anal sphincter tears: should it be performed by the overlapping sphincteroplasty technique? Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(8):1071–4.

    Article  PubMed  Google Scholar 

  35. RCOG. The management of third- and fourth-degree perineal tears. http://www.rcog.org.uk/files/rcog-corp/GTG2911022011.pdf. Cited 2014.

  36. Kettle C, Dowswell T, Ismail KM. Absorbable suture materials for primary repair of episiotomy and second degree tears. Cochrane Database Syst Rev. 2010;(6):CD000006. PubMed.

    Google Scholar 

  37. Mahomed K, Grant A, Ashurst H, James D. The Southmead perineal suture study. A randomized comparison of suture materials and suturing techniques for repair of perineal trauma. Br J Obstet Gynaecol. 1989;96(11):1272–80. PubMed.

    Article  CAS  PubMed  Google Scholar 

  38. Mackrodt C, Gordon B, Fern E, Ayers S, Truesdale A, Grant A. The Ipswich Childbirth Study: 2. A randomised comparison of polyglactin 910 with chromic catgut for postpartum perineal repair. Br J Obstet Gynaecol. 1998;105(4):441–5. PubMed.

    Article  CAS  PubMed  Google Scholar 

  39. Grant A. The choice of suture materials and techniques for repair of perineal trauma: an overview of the evidence from controlled trials. Br J Obstet Gynaecol. 1989;96(11):1281–9. PubMed.

    Article  CAS  PubMed  Google Scholar 

  40. Kettle C, Johanson RB. Absorbable synthetic versus catgut suture material for perineal repair. Cochrane Database Syst Rev. 2000;(2):CD000006. PubMed.

    Google Scholar 

  41. Kettle C, Hills RK, Jones P, Darby L, Gray R, Johanson R. Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomised controlled trial. Lancet. 2002;359(9325):2217–23. PubMed.

    Article  PubMed  Google Scholar 

  42. Leeman L, Spearman M, Rogers R. Repair of obstetric perineal lacerations. Am Fam Physician. 2003;68(8):1585–90. PubMed.

    PubMed  Google Scholar 

  43. Fargeaudou Y, Soyer P, Morel O, Sirol M, le Dref O, Boudiaf M, et al. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization. Eur Radiol. 2009;19(9):2197–203. PubMed.

    Article  PubMed  Google Scholar 

  44. Melody GF. Paravaginal hematomas; their recognition and management postpartum. Calif Med. 1955;82(1):16–8. PubMed Pubmed Central PMCID: 1532250.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Tattersall M, Braithwaite W. Balloon tamponade for vaginal lacerations causing severe postpartum haemorrhage. BJOG. 2007;114(5):647–8. PubMed.

    Article  CAS  PubMed  Google Scholar 

  46. RCOG. http://www.rcog.org.uk/stratog/page/para-genital-haematomas. Cited 02-1014.

  47. Brandon C, Jacobson JA, Low LK, Park L, DeLancey J, Miller J. Pubic bone injuries in primiparous women: magnetic resonance imaging in detection and differential diagnosis of structural injury. Ultrasound Obstet Gynecol. 2012;39(4):444–51. PubMed.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Grant A, Gordon B, Mackrodat C, Fern E, Truesdale A, Ayers S. The Ipswich childbirth study: one year follow up of alternative methods used in perineal repair. BJOG. 2001;108(1):34–40. PubMed.

    CAS  PubMed  Google Scholar 

  49. Abraham S, Child A, Ferry J, Vizzard J, Mira M. Recovery after childbirth: a preliminary prospective study. Med J Aust. 1990;152(1):9–12. PubMed.

    CAS  PubMed  Google Scholar 

  50. Macarthur AJ, Macarthur C. Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study. Am J Obstet Gynecol. 2004;191(4):1199–204. PubMed.

    Article  PubMed  Google Scholar 

  51. Fitzpatrick M, O’Herlihy C. Short-term and long-term effects of obstetric anal sphincter injury and their management. Curr Opin Obstet Gynecol. 2005;17(6):605–10. PubMed.

    Article  PubMed  Google Scholar 

  52. Doumouchtsis SK, Boama V, Gorti M, et al. Prospective evaluation of combined local bupivacaine and steroid injections for the management of chronic vaginal and perineal pain. Arch Gynecol Obstet. 2011;284(3):681–5. PubMed.

    Article  CAS  PubMed  Google Scholar 

  53. Kearney R, Miller JM, Ashton-Miller JA, DeLancey JO. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006;107(1):144–9. PubMed Pubmed Central PMCID: 2841321.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Dietz HP, Gillespie AV, Phadke P. Avulsion of the pubovisceral muscle associated with large vaginal tear after normal vaginal delivery at term. Aust N Z J Obstet Gynaecol. 2007;47(4):341–4. PubMed.

    Article  PubMed  Google Scholar 

  55. Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol. 2005;106(4):707–12. PubMed.

    Article  PubMed  Google Scholar 

  56. Tubaro A, Vodušek D, Amarenco G, et al. Imaging, neurophysiological testing and other tests. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 5th ICI. Paris: ICUD-EAU; 2013. p. 507–622.

    Google Scholar 

  57. Schwertner-Tiepelmann N, Thakar R, Sultan AH, Tunn R. Obstetric levator ani muscle injuries: current status. Ultrasound Obstet Gynecol. 2012;39(4):372–83. PubMed.

    Article  CAS  PubMed  Google Scholar 

  58. Cunningham FG, Williams JW. The Puerperium. In: Cunningham FG, et al. editors. Williams obstetrics. 23rd ed. New York: McGraw-Hill Medical; 2010. p. 677

    Google Scholar 

  59. Snow RE, Neubert AG. Peripartum pubic symphysis separation: a case series and review of the literature. Obstet Gynecol Surv. 1997;52(7):438–43. PubMed.

    Article  CAS  PubMed  Google Scholar 

  60. Nitsche JF, Howell T. Peripartum pubic symphysis separation: a case report and review of the literature. Obstet Gynecol Surv. 2011;66(3):153–8. PubMed.

    Article  PubMed  Google Scholar 

  61. Johnson A, Thakar R, Sultan AH. Obstetric perineal wound infection: is there underreporting? Br J Nurs. 2012;21(5):S28, S30, S32–5. PubMed.

    Google Scholar 

  62. Sultan AH, Kamm MA, Hudson CN, Bartram CI. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ. 1994;308(6933):887–91. PubMed Pubmed Central PMCID: 2539832.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Duggal N, Mercado C, Daniels K, Bujor A, Caughey AB, El-Sayed YY. Antibiotic prophylaxis for prevention of postpartum perineal wound complications: a randomized controlled trial. Obstet Gynecol. 2008;111(6):1268–73. PubMed.

    Article  PubMed  Google Scholar 

  64. Ramin SM, Gilstrap 3rd LC. Episiotomy and early repair of dehiscence. Clin Obstet Gynecol. 1994;37(4):816–23. PubMed.

    Article  CAS  PubMed  Google Scholar 

  65. Williams MK, Chames MC. Risk factors for the breakdown of perineal laceration repair after vaginal delivery. Am J Obstet Gynecol. 2006;195(3):755–9. PubMed.

    Article  PubMed  Google Scholar 

  66. Goldaber KG, Wendel PJ, McIntire DD, Wendel Jr GD. Postpartum perineal morbidity after fourth-degree perineal repair. Am J Obstet Gynecol. 1993;168(2):489–93. PubMed.

    Article  CAS  PubMed  Google Scholar 

  67. Kamel A, Khaled M. Episiotomy and obstetric perineal wound dehiscence: beyond soreness. J Obstet Gynaecol. 2014;31. PubMed.

    Google Scholar 

  68. Robinson HE, O’Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol. 2005;106(6):1357–64. PubMed.

    Article  PubMed  Google Scholar 

  69. Snyder RR, Hammond TL, Hankins GD. Human papillomavirus associated with poor healing of episiotomy repairs. Obstet Gynecol. 1990;76(4):664–7. PubMed.

    CAS  PubMed  Google Scholar 

  70. Dudley LM, Kettle C, Ismail KM. Secondary suturing compared to non-suturing for broken down perineal wounds following childbirth. Cochrane Database Syst Rev. 2013;(9):CD008977. PubMed.

    Google Scholar 

  71. Ganapathy R, Bardis NS, Lamont RF. Secondary repair of the perineum following childbirth. J Obstet Gynaecol. 2008;28(6):608–13. PubMed.

    Article  CAS  PubMed  Google Scholar 

  72. Connolly A, Thorp J, Pahel L. Effects of pregnancy and childbirth on postpartum sexual function: a longitudinal prospective study. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(4):263–7. PubMed.

    Article  PubMed  Google Scholar 

  73. Phillips C, Monga A. Childbirth and the pelvic floor: “the gynaecological consequences”. Rev Gynaecol Pract. 2005;5(1):15–22.

    Article  Google Scholar 

  74. Lewis C, Williams AM, Rogers RG. Postpartum anal sphincter lacerations in a population with minimal exposure to episiotomy and operative vaginal delivery. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):41–5. PubMed.

    Article  PubMed  Google Scholar 

  75. de Oliveira Bernardes N, Bahamondes L. Intravaginal electrical stimulation for the treatment of chronic pelvic pain. J Reprod Med. 2005;50(4):267–72. PubMed.

    PubMed  Google Scholar 

  76. Vassallo BJ, Karram MM. Management of iatrogenic vaginal constriction. Obstet Gynecol. 2003;102(3):512–20. PubMed.

    PubMed  Google Scholar 

  77. Arkin AE, Chern-Hughes B. Case report: labial fusion postpartum and clinical management of labial lacerations. J Midwifery Womens Health. 2002;47(4):290–2. PubMed.

    Article  PubMed  Google Scholar 

  78. Miller S, Lester F, Webster M, Cowan B. Obstetric fistula: a preventable tragedy. J Midwifery Womens Health. 2005;50(4):286–94. PubMed.

    Article  PubMed  Google Scholar 

  79. WHO MHaSMP. The prevention and treatment of obstetric fistulae: report of a Technical Working Group, Geneva, 17–21 April, 1989: WHO/FHE/89.5. Geneva: Division of Family Health, WHO; 1989.

    Google Scholar 

  80. Mselle LT, Kohi TW, Mvungi A, Evjen-Olsen B, Moland KM. Waiting for attention and care: birthing accounts of women in rural Tanzania who developed obstetric fistula as an outcome of labour. BMC Pregnancy Childbirth. 2011;11:75. PubMed Pubmed Central PMCID: 3221614.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Silva-Filho AL, Santos-Filho AS, Figueiredo-Netto O, et al. Uncommon complications of sacrospinous fixation for treatment of vaginal vault prolapse. Archives of gynecology and obstetrics. 2005;271(4):358-62. PubMed PMID: 15650835.

    Google Scholar 

  82. Chandru S, Naffe T, Ismail K, et al. Evaluation of modified Fenton procedure for persistent superficial dyspareunia following childbirth. Gynecol Surg. 2009;7:245–248.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Queen’s Hospital, BHR University Hospitals, NHS trust, Essex, UK

    Kostis I. Nikolopoulos MD, MSc

  2. Department of obstetrics and gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Stergios K. Doumouchtsis MSc, MPH, PhD, MRCOG

  3. University of Athens, Medical School, Athens, Greece

    Stergios K. Doumouchtsis MSc, MPH, PhD, MRCOG

Authors
  1. Kostis I. Nikolopoulos MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stergios K. Doumouchtsis MSc, MPH, PhD, MRCOG
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kostis I. Nikolopoulos MD, MSc .

Editor information

Editors and Affiliations

  1. St George's University of London, London, United Kingdom

    Stergios K Doumouchtsis

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer-Verlag London

About this chapter

Cite this chapter

Nikolopoulos, K.I., Doumouchtsis, S.K. (2017). Healing Process and Complications. In: Doumouchtsis, S. (eds) Childbirth Trauma. Springer, London. https://doi.org/10.1007/978-1-4471-6711-2_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6711-2_13

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6710-5

  • Online ISBN: 978-1-4471-6711-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation