Perineal Trauma in a Low-risk Maternity with High Prevalence of Upright Position during the Second Stage of Labor

Abstract

Objective Perineal trauma is a negative outcome during labor, and until now it is unclear if the maternal position during the second stage of labor may influence the risk of acquiring severe perineal trauma. We have aimed to determine the prevalence of perineal trauma and its risk factors in a low-risk maternity with a high incidence of upright position during the second stage of labor. Methods A retrospective cohort study of 264 singleton pregnancies during labor was performed at a low-risk pregnancy maternity during a 6-month period. Perineal trauma was classified according to the Royal College of Obstetricians and Gynecologists (RCOG), and perineal integrity was divided into three categories: no tears; first/ second-degree tears þ episiotomy; and third and fourth-degree tears. A multinomial analysis was performed to search for associated factors of perineal trauma. Results From a total of 264 women, there were 2 cases (0.75%) of severe perineal trauma, which occurred in nulliparous women younger than 25 years old. Approximately 46% (121) of the women had no tears, and 7.95% (21) performed mediolateral episiotomies. Perineal trauma was not associated with maternal position (p ¼ 0.285), health professional (obstetricians or midwives; p ¼ 0.231), newborns with 4 kilos or more (p ¼ 0.672), and labor analgesia (p ¼ 0.319). The multinomial analysis showed that white and nulliparous presented, respectively, 3.90 and 2.90 times more risk of presenting perineal tears. Conclusion The incidence of severe perineal trauma was low. The prevalence of upright position during the second stage of labor was 42%. White and nulliparous women were more prone to develop perineal tears.

Effects of flexible sacrum positions during the second stage of labour on maternal and neonatal outcomes: A systematic review and meta‐analysis

“…Regarding blood loss during childbirth, previous studies also showed no clear difference among maternal positions (Deliktas & Kukulu, 2018;Gupta et al, 2017;Long & Lin, 2018;Peppe et al, 2018;Walker et al, 2018). As for other outcomes, no clear difference was spotted between groups concerning foetal and neonatal outcomes, which agreed with many previous studies (Bick et al, 2017;De Jonge et al, 2004;Gupta et al, 2017;Thies-Lagergren, Kvist, Sandin-Bojo, Christensson, & Hildingsson, 2013;Walker et al, 2018).…”

Effects of upright positions during the second stage of labour for women without epidural analgesia: A meta‐analysis

“…The protective effect of upright positions on severe perineal trauma should be considered with caution because the total number of women in the included studies was small. Several cohort studies, however, did not show a significant difference between upright and recumbent positions (Peppe et al., 2018; Reis et al., 2018). A cross‐sectional study demonstrated that the kneeling position had the lowest risk of OASIS, whereas the supine position was associated with an increased risk of OASIS (Tunestveit et al., 2018).…”

“…Many studies have indicated that upright positions significantly shorten the second stage of labour (Moraloglu et al., 2017; Thies‐Lagergren et al., 2013), reduce the rate of operative delivery (Gardosi et al., 1989; Walker et al., 2012) and episiotomy (Gizzo et al., 2014) but also increase the amount of bleeding after childbirth (Thies‐Lagergren et al., 2011) and the rate of obstetric anal sphincter injuries (OASIS; Griffiths et al., 2018; Haslinger et al., 2015). Several researchers, however, found no substantial differences in the duration of the second stage of labour (Lin et al., 2018), the rate of episiotomy (Gupta et al., 1989) and OASIS (Peppe et al., 2018; Reis et al., 2018), or postpartum haemorrhage (Moraloglu et al., 2017) between upright and supine positions.…”

Efeitos da fisioterapia durante o parto em um hospital da região amazônica: Um estudo piloto

“…Outro desfecho encontrado neste estudo foi a laceração perineal, constatou-se relação da laceração com a primiparidade. Corroborando com Peppe et al (2018), que associa este evento com a paridade e a idade da mãe, em seu estudo mulheres primigestas e jovens tiveram maior propensão a sofrerem trauma perineal, não havendo associação entre os dados antropométricos do RN e a posição de parto, vertical ou horizontal (Peppe et al, 2018). Outro estudo analisou os fatores que aumentam o número de lesão perineal e constatou que o uso de ocitocina, manobra de valsalva e a posição de parto horizontal provocam maior taxa de laceração (Tunestveit et al, 2018).…”