Peripartal Maternal Trauma

This prospective interventional before and after study evaluates whether structured obstetric training-covering perineal protection, improved episiotomy technique, systematic detection of obstetric anal sphincter injuries (OASI), and hands on OASI repair-can improve early postpartum quality of life and reduce peripartal pelvic floor trauma in primiparous women after term vaginal delivery. The primary aim is to determine whether the intervention decreases the incidence of postpartum anal incontinence and stress urinary incontinence. Secondary objectives include assessing changes in ultrasound based markers of pelvic floor integrity, specifically levator ani avulsion, urethral mobility or descent, pelvic organ prolapse parameters, and anal sphincter defects. The study population consists exclusively of primiparous women following their first term vaginal birth, minimizing confounding from prior obstetric history. Before the training intervention, a baseline cohort was enrolled under standard obstetric practice. After all obstetric staff (physicians and midwives) completed the structured hands on training program, a post intervention cohort was enrolled, with care provided using the newly implemented techniques. All participants undergo standardized assessment three months postpartum, including quality of life questionnaires focused on pelvic floor symptoms and transperineal ultrasound examination according to the method described by Dietz, evaluating levator ani integrity, urethral mobility, and pelvic organ support.