Anal sphincter lacerations and upright delivery postures—a risk analysis from a randomized controlled trial

Altman, Daniel; Ragnar, Inga; Ekström, Åsa; Tydén, Tanja; Olsson, Sven-Eric

doi:10.1007/s00192-006-0123-9

Cited by 43 publications

(26 citation statements)

References 23 publications

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“…Several risk factors for high-grade perineal traumas during birth, such as primiparity [7,18] , the use of forceps [3,8,12] or vacuum [17] , fundal pressure [18] , increased birth weight [3,12,18] , occipitoposterior position during delivery [7,17] , prolonged second stage [1,17] , midline episiotomies [3,18] and postmaturity [18] have been described. However, there is limited information about the influence of maternal position at birth on perineal damage.…”

Section: Introductionmentioning

confidence: 99%

Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study

Haslinger

Burkhardt

Stoiber

et al. 2014

Journal of Perinatal Medicine

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Objective:This work aimed to analyze the association between maternal position at birth in spontaneous deliveries and the occurrence of anal sphincter tears (AST) given the lack of evidence related to the least traumatic birth position. Study design: A total of 7832 vaginal deliveries were included. Vaginal-operative deliveries and deliveries with fundal pressure were excluded. Birth positions on bed, in water, kneeling, and in a squatting position on a low stool were compared. Birth position on bed was considered as the reference group, and a logistic regression analysis adjusting for important fetomaternal parameters was performed. Results: The overall incidence of AST was 1.1%. AST rate was significantly increased in squatting (2.9%) and kneeling (2.1%) positions compared with birth position on bed (1.0%) or in water (0.9%). Logistic regression analysis revealed a significantly higher risk for ASTs in squatting (OR 2.92, CI 95% 1.04-8.18) and in kneeling positions (OR 2.14, CI 95% 1.05-4.37) compared with the reference group on bed. When adjusting for risk factors, birth in a kneeling position remained significantly associated with ASTs (adj. OR 2.21, CI 95% 1.07-4.54). Conclusions: Birth in squatting or in kneeling position is associated with an elevated risk for ASTs. Birth in water is not associated with an increased risk for AST. Based on the results, women should be informed about the association of certain birth positions with the occurrence of AST. given the lack of evidence related to the least traumatic birth position. Study design : A total of 7832 vaginal deliveries were included. Vaginal-operative deliveries and deliveries with fundal pressure were excluded. Birth positions on bed, in water, kneeling, and in a squatting position on a low stool were compared. Birth position on bed was considered as the reference group, and a logistic regression analysis adjusting for important fetomaternal parameters was performed. Results : The overall incidence of AST was 1.1%. AST rate was significantly increased in squatting (2.9%) and kneeling (2.1%) positions compared with birth position on bed (1.0%) or in water (0.9%). Logistic regression analysis revealed a significantly higher risk for ASTs in squatting (OR 2.92, CI 95% 1. 04 -8.18) and in kneeling positions (OR 2.14, CI 95% 1.05 -4.37) compared with the reference group on bed. When adjusting for risk factors, birth in a kneeling position remained significantly associated with ASTs (adj. OR 2.21, CI 95% 1.07 -4.54). Conclusions : Birth in squatting or in kneeling position is associated with an elevated risk for ASTs. Birth in water is not associated with an increased risk for AST. Based on the results, women should be informed about the association of certain birth positions with the occurrence of AST.

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Section: Introductionmentioning

confidence: 99%

Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study

Haslinger

Burkhardt

Stoiber

et al. 2014

Journal of Perinatal Medicine

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“…The greatest incidence of intact perinea was found with all-fours position, with kneeling a close second, Rates above 50% were found in the majority of studies (Altman et al, 2007, Shorten et al, 2002, Soong and Barnes, 2005.…”

Section: All-fours and Kneeling Positionsmentioning

confidence: 84%

“…The academic supervisor offered ongoing support to reduce the risk of bias. Table 4 gives an overview of the included studies and (Altman et al, 2007), the other six were cohort studies, all deemed to be weaker in relation to quality and risk of bias when assessed using the CCRB tool (Higgins et al, 2011, Lodge, 2015. Authors justified not selecting a RCT from an ethical perspective, that restricting women to certain positions and withholding choices could not be ethically justified.…”

Section: Methodsmentioning

confidence: 99%

“…Sitting, Squatting and Using a Birth-stool: These positions were found to have the highest incidence and degree of perineal trauma with rates being up to 85.7% for primiparous women (Altman et al, 2007). Rates of 2 nd degree tear (or 1 st and 2 nd combined) was around 50% (Altman et al, 2007, Shorten et al, 2002, Soong and Barnes, 2005.…”

Section: All-fours and Kneeling Positionsmentioning

confidence: 99%

“…However, Altman et al (2007) and Cortes et al (2011) documented all degrees of perineal trauma as one outcome (Altman et al, 2007, Cortes et al, 2011 and others included anterior trauma in addition , Geissbuehler et al, 2004.…”

Section: All-fours and Kneeling Positionsmentioning

confidence: 99%

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The effect of maternal position at birth on perineal trauma: A systematic review

Lodge

Haith-Cooper

2016

British Journal of Midwifery

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Perineal trauma is associated with short and long term maternal morbidity. Research has found that maternal position at birth can influence perineal trauma. However, no evidence examining specific maternal positions, including waterbirth and how these can influence incidence and degree of perineal trauma could be found. The evidence is important to help reduce trauma rates and improve information for women and midwives.To address this dearth in reliable evidence, a systematic review was conducted.Seven studies met the inclusion criteria. Compared to landbirth, waterbirth was found to cause an increase in perineal trauma. Kneeling and all-fours positions were most protective of an intact perineum. Allowing for different variables; sitting, squatting and using a birth-stool caused the greatest incidence of trauma.The findings of this review demonstrate further research is required around perineal guarding in alternative birth positions and how parity affects trauma rates with waterbirth in order that women may be advised appropriately. However, this review suggests findings that midwives can use when discussing alternative birth positions with women.

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Position in the second stage of labour for women without epidural anaesthesia

Gupta

Hofmeyr

2004

Cochrane Database of Systematic Reviews

117

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Upright or lateral position compared with supine or lithotomy positions. Secondary comparisons with different upright positions and the lateral position were made. Outcomes:Maternal outcomes included pain during delivery, duration of labour, mode of delivery, trauma to the birth canal that required suturing, blood loss greater than 500 ml; fetal outcomes were also described, including admission to intensive care unit and perinatal death.

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Anal sphincter lacerations and upright delivery postures—a risk analysis from a randomized controlled trial

Cited by 43 publications

References 23 publications

Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study

Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study

The effect of maternal position at birth on perineal trauma: A systematic review

Position in the second stage of labour for women without epidural anaesthesia

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