2019 SCIENCELINE

Journal of Life Science and Biomedicine

J Life Sci Biomed, 9 (5): 122-125, 2019

License: CC BY 4.0

ISSN 2251-9939

DOI: https://dx.doi.org/10.36380/scil.2019.jlsb19

Analysis of the post-partum vaginal repair by

injecting platelet-rich plasma; a study undertaken

in Saudi German hospital K.S.A

Dr. Hassan El Motawkel Ala Allah HASSAN SOLIMAN^

HOD & Consultant Obstetrics & Gynecology, Saudi German Hospital, Aseer, KSA.

Corresponding author’s Email: obgyn1.asr@sghgroup.net

Research Article

PII: S225199391900019-9

ABSTRACT

Aim. The research was based on the objective of vaginal recovery after vaginal delivery of

women. PRP was used to determine whether the effects of the injecting PRP on vagina made

any difference on vaginal prolapse repair or not. Therefore, the primary goal was to find the

application of the PRP on the case of vaginal tear recovery of the mothers. Methods. The

observational approach was utilized to conduct the following research. We examined

(p=210) participants, while study duration was 10 months from November 2017 to August

2018. Results. The outcomes were 100% positive in the researcher’s cohort since all the

participants responded well while recovered fast than the usual estimated time. Conclusion.

Injecting PRP for repairing vaginal tear is considered to be optimizing for the general

medical background patients whereas, for the long-term follow-up, the study requires to get

the large numbers of participants in order to make the research generic.

Rec. 06 June 2019

Rev. 24 August 2019

Pub. 25 September 2019

Keywords

Post-Partum,

Vaginal Tear,

Vaginal Repair,

Platelet-Rich Plasma,

Gynecological Study

INTRODUCTION

During the vaginal delivery, it is common to have perineal postpartum tear due to stretching of the vagina. It

usually causes the tear of vaginal layers which eventually causes the temporary injury [1 ]. The degrees of

vaginal tears are divided into 4 categories. While these degrees depend upon the severity of the tear. In the first

degree tear, it includes the tear of vaginal mucosa and the connective tissue [2 ]. In the second degree tear, it

involves the tear of vaginal mucosa and connective tissue along with the underlying muscles. For the third

degree tear, it involves the complete transection of an anal sphincter [3-5 ]. And the last degree tear includes the

tear of rectal mucosa [6 ]. A woman may suffer from any of these after delivery while just how there are several

degrees of injury [7 ], there are different method for its recovery as well [8, 9 ].

The following research is based on the postpartum vaginal repair by injecting Platelet-rich plasma (PRP).

The primary objective of the research study is to analyze and evaluate the use and benefits of PRP in order to

know its significance and in the area of postpartum vaginal repair.

MATERIAL AND METHODS

Ethical approval

The review board and ethics committee of Saudi German Hospital, Aseer approved the study protocol and

informed consents were taken from all the participants.

The observational study method was implied in the following research. The study was undertaken at tertiary

referral unit in K.S.A. Saudi German Hospital, Aseer. Whereas the participants were under observation for the

research purposes. The participants for the research comprised of 210 laboring women between 22-46 years old.

Limitations

The study includes some of the significant limitations which are significant to come in the observation.

Those are given as follow:

Citation: Hassan Soliman HE-MAA 2019. Analysis of the post-partum vaginal repair by injecting platelet-rich plasma; a study undertaken in Saudi German

hospital K.S.A. J Life Sci Biomed, 2019; 9(5): 122-125; www.jlsb.science-line.com

122

The observational study lacks in providing the conclusive results or the authentic evidence as a result.

Moreover, date limitations also play their role in making evidence weak. In order to overcome these limitations,

it is essential to conduct a randomized controlled trial. The sample size of the participants limits the research to

get appropriate conclusion and generalized outcome. For that reason, it is essential to carry the evidence-based

research along with the large sample to make the outcomes generalized.

Procedure and Analysis

The following study was undertaken in the time period of 10 months in which 210 laboring women

between the ages of 22 to 46 were the participants. These participants were critically observed in order to

analyze the application of PRP in vaginal repair.

The infiltration was made by using 20ml of Lidocaine (2%) with 1 Amp Vasopressin 20 IU + 30 ml Normal

Saline +/- Sedation Inj. Dormicum 15mg/3ml. the major factors that have the significant role in the observational

study include The Surgical Technique including Vaginoplasty and Perinorraphy which depends upon pre-

delivery evaluation of vaginal laxity, widening, distance between the vagina and anus, any varicosities and mass.

Following the experimental procedure, the participants were provided the sedation and after that the

vasoconstrictor and local Analgesia Solution in both vaginal wall and perineum. The re-evaluation after the

delivery was performed which further included: Careful dissection of the vaginal wall equally starting from the

apex till the mucocutaneous junction at the introitus, two to three stitches at the deep and superficial perineal

muscles and levator ani muscles and removal of the all excess vaginal tissues. After that the procedure

proceeded by suturing the vaginal wall starting from the apex until the hymen ring and the one deep as well as

a high stitch to approximate the bulbospongiosus muscle on both sides. The suturing was completed until the

mucocutaneous junction while two or three stitches were tied muscles and interrupted stitches including

subcuticular stitches of the perineal area. After completion of the repair process, inject ± 4.5 – 5ml of PRP which

was already prepared at the time of delivery after extraction of 8-9 ml blood from the patient and put in the

tube and centrifuge for 5 minutes to separate the PRP from the whole blood. Afterwards the PRP is injected to

subcutaneous and subvaginal for further experimental approach. In the last compression and assurance of the

heamostasis by vaginal back after catheterization, analgesia (mainly non-steroidal anti-inflammatory supple-

ments) was done.

Furthermore, the statistical measurements of the parity and the age of participants are elaborated in

tables 1 and 2. Any participant with any medical disorders e.g. hypertensive, diabetic, hypothyroid was well

controlled before implication of the treatment. Thirteen of the women were diagnosed with hypertensive but

not pre-eclampsia symptoms. Seventeen of them were Anemic with the Hb below 10.5. 41 of the women were

diagnosed diabetic while the experiment was obtained on total 210 numbers of women from 22 to 46 years of

age. Weight of the participants was measured between 63 to 114 kg.

Table 1. Characteristics of the participants of the study

Characteristics

Age

22-46 years

69-117 kg

Weight

Medical disorder

Diabetic

14.76 %

6.19 %

Hypertensive

Hypothyroid

Epilepsy

27.14 %

0.95 %

Multiple medical disorder

Diabetic and hypertensive

Diabetic and hypothyroid

Hypertensive and hypothyroid

5.23 %

1.42 %

3.33 %

Parity

P1 – P5

P6 – P11

66.19 %

33.80 %

Citation: Hassan Soliman HE-MAA 2019. Analysis of the post-partum vaginal repair by injecting platelet-rich plasma; a study undertaken in Saudi German

hospital K.S.A. J Life Sci Biomed, 2019; 9(5): 122-125; www.jlsb.science-line.com

123

Table 2. Vaginal prolapse of the participant

Vaginal prolapse

Percentage

19.52 %

Minor degree (1^stdegree tear)

Moderate degree (2^nddegree tear)

Severe degree (3^rddegree tear)

52.85 %

22.61 %

RESULTS AND DISCUSSION

After deeply analyzing the outcomes and observations made on the participant in ten months’ time period, the

researcher concluded the approach towards vaginal repair immediately after delivery is effective and more

feasible. Furthermore, it adverts that the addition of vasopressin and lidocaine infiltration helps to prevent

heavy blood loss and leads to prolong the analgesic effect. There were multiple more advantages observed

during the observation like more analgesics time, cosmetic appearance, less infection and less dehiscence of the

wound. Therefore the participant of the study (p=210) along with mediocre medical background responded well

to the experimental vaginal repair experiment. Hence, the study was proved to be 100% successful whereas, for

long-term follow-up, there is a need for large sample of participants for further evaluation and comparison.

The average size of a baby’s head is 11.4 centimeters in diameter. The average diameter of a woman’s

vagina (according to a study) is 2.1 to 3.5 centimeters [10 ]. This initiates the scenario of complication in delivery

[9-12 ]. Perhaps, some of the women do not require vaginal tear to deliver a child but some of them experience

different degrees of the vaginal tear [13 ]. The process of repairing vagina take long while the sensitivity of area

makes it critical to handle [14 ]. That is why different approaches are usually followed in order to speed up the

repair of an organ [15 ]. Usually the initial steps for the tear include suturing and stitches after that different

medicines are used to cure the stitches further [13, 15 ]. This particular research follows the idea of injecting PRP

for speeding up the process of vaginal repair while the observational study was prioritized on the basis of its

advantages defined as follow:

Through the PRP approach for vaginal repair, there is a significant decrease in blood loss as well as time of

the repair [15, 16 ]. It provides more analgesics time while providing more cosmetic appearance later on [15 ].

There are also very fewer chances of infection as dehiscence of the wound as per the results advert. For the

concept of PR, the Plasma is the portion of liquid which contains whole blood. It has the large of water and

proteins, platelets to circulate within the body for healing purpose [14 ]. Platelet activation plays a key role in the

body's natural healing process [15 ]. Its major application is to heal the tissues of the body and has been used for

multiple medical purposes in history.

CONCLUSION

The applications of Platelet-rich plasma (PRP) was proved to be significant for the vaginal repair after first,

second and third-degree tear of women during vaginal delivery. The necessary measurements were made to

check the medical condition of the study participants and the approach towards new treatment was applied to

them in order to observe its outcomes. The researcher took the consent of the laboring women before the

experiment and it was conducted with all security measures from healthcare perspective.

DECLARATIONS

Funding Statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-

for-profit sectors.

Conflict of interests

Authors do not have any conflict of interests.

REFERENCES

1. Woodman PJ and Graney DO. Anatomy and physiology of the female perineal body with relevance to obstetrical injury

and repair. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British

Association of Clinical Anatomists, 2002, 15(5), pp.321-334. (Search Google Scholar ; Export Citation as EndNote )

Citation: Hassan Soliman HE-MAA 2019. Analysis of the post-partum vaginal repair by injecting platelet-rich plasma; a study undertaken in Saudi German

hospital K.S.A. J Life Sci Biomed, 2019; 9(5): 122-125; www.jlsb.science-line.com

124

2. Weber AM and Walters MD. Anterior vaginal prolapse: review of anatomy and techniques of surgical repair. Obstetrics

& Gynecology, 1997, 89(2), pp.311-318. (Search Google Scholar ; Export Citation as EndNote )

3. Majhail NS, Rizzo JD, Lee SJ., Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S and Seber A.

Recommended screening and preventive practices for long-term survivors after hematopoietic cell

transplantation. Hematology/oncology and Stem Cell Therapy, 2012, 5(1), pp.1-30. (Search Google Scholar

;

Export

Citation as EndNote )

4. Petros PP. Development of generic models for ambulatory vaginal surgery—a preliminary report. International

Urogynecology Journal, 1998, 9(1), pp.19-27. (Search Google Scholar ; Export Citation as EndNote )

5. Petros PEP and Ulmsten UI. An integral theory of female urinary incontinence: experimental and clinical

considerations. Acta Obstetricia et Gynecologica Scandinavica, 1990, 69(S153), pp.7-31. (Search Google Scholar ; Export

Citation as EndNote )

6. Haylen BT, De Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK and Schaer GN,

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the

terminology for female pelvic floor dysfunction. Neurourology and Urodynamics: Official Journal of the International

Continence Society, 2010, 29(1), pp.4-20. (Search Google Scholar ; Export Citation as EndNote )

7. Pathi SD, Acevedo JF, Keller PW, Kishore AH, Miller RT, Wai CY and Word RA. Recovery of the injured external anal

sphincter after injection of local or intravenous mesenchymal stem cells. Obstetrics & Gynecology, 2012, 119(1), pp.134-

144. (Search Google Scholar ; Export Citation as EndNote )

8. Gyhagen M1, Bullarbo M, Nielsen TF and Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after

childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG: An International

Journal of Obstetrics & Gynaecology, 2013, 120(2), pp.152-160. (Search Google Scholar ; Export Citation as EndNote )

9. Dietz HP, Pelvic floor trauma in childbirth. Australian and New Zealand Journal of Obstetrics and Gynaecology, 2013, 53(3),

pp.220-230. (Search Google Scholar ; Export Citation as EndNote )

10. Dietz HP, Shek KL, Chantarasorn V and Langer SE, Do women notice the effect of childbirth‐related pelvic floor

trauma? Australian and New Zealand Journal of Obstetrics and Gynaecology, 2012, 52(3), pp.277-281. (Search Google

Scholar ; Export Citation as EndNote )

11. Pergialiotis V, Vlachos D, Protopapas A, Pappa K and Vlachos G. Risk factors for severe perineal lacerations during

childbirth. International Journal of Gynecology & Obstetrics, 2014, 125(1), pp.6-14. (Search Google Scholar ; Export Citation

as EndNote )

12. De Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H and Tol JL. Platelet-rich plasma injection

for chronic Achilles tendinopathy: a randomized controlled trial. Jama, 2010, 303(2), pp.144-149. (Search Google Scholar

; Export Citation as EndNote )

13. Hauck YL, Lewis L, Nathan EA, White C and Doherty DA, Risk factors for severe perineal trauma during vaginal

childbirth: a Western Australian retrospective cohort study. Women and Birth, 2015, 28(1), pp.16-20. (Search Google

Scholar ; Export Citation as EndNote )

14. Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S and Marcacci M. Platelet-rich

plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surgery, Sports

Traumatology, Arthroscopy, 2010, 18(4), pp.472-479. (Search Google Scholar ; Export Citation as EndNote )

15. Lacci, K.M. and Dardik, A., Platelet-rich plasma: support for its use in wound healing. The Yale Journal of Biology and

Medicine, 2010, 83(1), p.1. (Search Google Scholar ; Export Citation as EndNote )

16. Castricini R, Longo UG, De Benedetto M, Panfoli N, Pirani P, Zini R, Maffulli N and Denaro V. Platelet-rich plasma

augmentation for arthroscopic rotator cuff repair: a randomized controlled trial. The American journal of sports

medicine, 2011, 39(2), pp.258-265. (Search Google Scholar ; Export Citation as EndNote )

Citation: Hassan Soliman HE-MAA 2019. Analysis of the post-partum vaginal repair by injecting platelet-rich plasma; a study undertaken in Saudi German

hospital K.S.A. J Life Sci Biomed, 2019; 9(5): 122-125; www.jlsb.science-line.com

125