factors for perineal lacerations requiring suture in vaginal deliveries without episiotomy.
METHODS:We conducted a prospective cohort study including 400 vaginal deliveries assisted in a public hospital in Brazil. During the second stage of labor, maneuvers as such directed pushing, fundal pressure, and Valsalva maneuver were avoided. A policy of no episiotomy was followed with strategies for perineal protection that included warm compresses and intrapartum perineal massage. We calculated the relative risk and its 95% confidence interval (95% CI). Multivariate analysis was performed to determine the adjusted risk of need for suture.
RESULTS:We analyzed 400 women who had vaginal deliveries with no episiotomy and 6% of instrumental deliveries. The rate of perineal lacerations in primiparous (210) was 56.7% and in multiparous (190) 30%. Suture was necessary in 23% of women (30% of primiparous and 15.3% of multiparous). In multivariate analysis, the factors that remained associated with increased risk of need for suture were primiparity (adjusted risk 1.81, 95% CI 1.25-2.89) and instrumental delivery (adjusted risk 3.78, 95% CI 1.21-18.66).CONCLUSION: There was a reduced need for suture in vaginal deliveries with the application of a protocol of perineal protection and no episiotomy. Primiparity and instrumental delivery were associated with increased risk of need for suture.Financial Disclosure:
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