Pelvic floor symptoms after second-degree tear or episiotomy and the consequences of healing complications: long-term follow-up after the REPAIR study.

Background

Prophylactic antibiotics reduce the risk of wound complications after second-degree perineal tears and episiotomy. However, the long-term consequences of experiencing a wound complication remain poorly studied.

Objective

(1) To evaluate the frequency of pelvic floor symptoms after second-degree tear and episiotomy and (2) to evaluate whether women who developed a wound complication had more pelvic floor symptoms 9 to 12 months postpartum compared to women without wound complications.

Study design

This study is a long-term follow-up of participants enrolled in the REPAIR study, a single-center, placebo-controlled, randomized trial conducted at a university hospital in Denmark. The original trial enrolled 442 women with a second-degree perineal tear or episiotomy to assess the effect of prophylactic antibiotics on wound complications. Long-term outcomes were assessed using 2 data sources: a pelvic floor questionnaire and a late postpartum follow-up clinical examination. Analyses of questionnaire-based outcomes included all women who completed the pelvic floor questionnaire regardless of attendance to the clinical examination. Analyses of outcomes from the clinical examination were restricted to women who attended the late postpartum follow-up visit.

Results

Of the 442 women included in the REPAIR study, 433 had information on wound healing status, of whom 51 (12%) experienced a clinically relevant complication. A total of 378 women completed the pelvic floor questionnaire and 362 attended the late postpartum follow-up. Pelvic floor symptoms were common across incontinence, prolapse, and sexual domains. Women with wound complications reported higher prevalences of symptoms, particularly related to sexual function, prolapse, and lower body image scores. This remained stable after adjustment for obstetric factors associated with wound complications. In the clinical examination, diagnostic prolapse was more frequent among women with wound complications, while anatomical prolapse and pelvic floor measurements were similar between groups.

Conclusion

Pelvic floor symptoms were common 9 to 12 months after second-degree tears or episiotomy. Women with postpartum wound complications reported more symptoms, particularly related to sexual function, prolapse, and body image. These findings suggest that wound healing is associated with long-term pelvic floor health and support attention to prevention and follow-up.