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.