Results
The cohort of eighteen pregnant women completed the study and delivered
vaginally live neonates with implementing a newly developed Ostrzenski’s
vaginal outlectomy. All pregnancies were singleton with a fetus in a
longitudinal lie, a cephalic presentation, and occiput anterior. A
summary of the maternal demographic profile is presented in Tabl. 2, and
maternal clinical characteristics summarized in Tabl. 3. Vaginal
outlectomy outcome measures are reported in Tabl. 4. The neonatal
clinical outcome is encapsulated in Tabl. 5. The neonatal APGAR score at
5 minutes was between 8 and 10 (median 9 ±1), and median birth weight of
3.314 gm ± 684 gm. Neonatal clinical characteristics are summarized in
Tabl. 5.
When a fetal head is crowning, the fragment of the visible belt-like
structure of the vaginal outlet can be identified, Fig.1A and Fig. 1B,
Fig. 2B, and Fig. 3. A small V-shape excision of the vaginal outlet
structure reduced the tissue’s resistance force on the fetal head during
birth enough. Immediately postpartum, none of the subjects from this
study group reported moderate or severe postpartum perineal pain.
Additionally, at three months follow up, including the patient who had
experienced vaginal outlectomy extension tear, did not report
superficial or deep dyspareunia.
The outlectorrhaphy required two or three interrupted absorbable sutures
to close the surgical defect. Esthetically, the wound closure resulted
in fine scar formation and no complications in wound healing in this
study group, Fig. 4. Additionally, the postpartum vaginal opening was
not gaping following outlectorrhaphy in every subject of the present
study, Fig. 4.
Utilizing the Validated Numerical Pain Rating Scale to record perineal
pain intensity on the first postpartum day showed no moderate or severe
perineal pain in all subjects who underwent Ostrzenski’s vaginal
outlectomy. The mild perineal discomfort subsided spontaneously without
pain medication on the second and third postpartum days. Furthermore, no
woman in this group reported dyspareunia at twelve-week.
One case out of 18 subjects experienced vaginal outlectomy excision tear
that included the vulvar skin, perineal fascia, right bulbospongiosus
muscle (the second degree) with the increased amount of bleeding
compared to uncomplicated Ostrzenski’s vaginal outlectomy, and the
neonatal birth weight was 3,390 gm. However, the vaginal wall,
corrugator muscle, and external anal sphincter were intact in this case,
Fig. 5B. In addition, this pregnant woman presented at full-term being
in active labor, and no malpresentation was diagnosed.