Factors Associated With Perineal Lacerations Requiring Suture in Vaginal Births Without Episiotomy

Leal, Nicole V.; Amorim, Melânia Maria Ramos; Franca-Neto, Antonio H.; Leite, Débora Farias Batista; Melo, Fabiana O.; Alves, Janio N.

doi:10.1097/01.aog.0000447369.00977.4c

Cited by 11 publications

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“…In relation to the type of completion of vaginal birth , instrumentation can be considered a risk factor for episiotomy compared with a normal birth (93% vs 38.7%; RR=1.84). This statistic coincides with the findings of numerous authors ( 6 , 10 - 11 ) . The number of episiotomies and instrumented births increases with the complexity of the hospital.…”

Section: Discussionsupporting

confidence: 93%

Episiotomy and its relationship to various clinical variables that influence its performance

Ballesteros-Meseguer

Carrillo‐Garcia

Pedro

et al. 2016

Rev. Latino-Am. Enfermagem

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Objective:to understand the episiotomy rate and its relationship with various clinical variables. Method:a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. Variables: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. Results:the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. Conclusions:episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure.

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Section: Discussionsupporting

confidence: 93%

Episiotomy and its relationship to various clinical variables that influence its performance

Ballesteros-Meseguer

Carrillo‐Garcia

Pedro

et al. 2016

Rev. Latino-Am. Enfermagem

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“…In a recent study, the rate of perineal lacerations in primiparous with no episiotomy was 56.7% and suture was necessary in 30% of them. The only factors associated with increased risk of need for suture were primiparity and instrumental delivery (21). Approximately two-thirds of the primiparous women with spontaneous vaginal deliveries experienced some degree of trauma that affected the perineal muscles, whether was caused by episiotomy or by a spontaneous second degree tear.…”

Section: Discussionmentioning

confidence: 99%

Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

Irene¹,

Sanchez²,

Francisco³

et al. 2015

IJWHR

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IntroductionHistorically, the use of episiotomy was common for primiparous women in order to prevent severe perineal trauma. Paradoxically, reviews indicate the opposite: episiotomy may actually contribute to severe perineal trauma rather than protect against it (1-4). Although current practice favours a reduction in episiotomies, perineal trauma rates remain high because of the increase in first and second degree tears (2,5,6). Prevalence rates of third and fourth degree perineal lacerations ranges widely from 0.3% to 6% or approximately 1.7% of all births (2.9% in primiparous). Most studies focus on the incidence and the risk factors of more severe perineal trauma including the anal sphincter (7-10). However, few studies have evaluated the incidence of perineal tears that do not affect the anal sphincter. Perineal tears are common following spontaneous vaginal deliveries and practically inevitable in forceps-assisted births (11). Even in mild tears, second degree perineal trauma deserves special consideration as it affects the muscular structure. The muscular damage classified as a second degree tear is equal to or worse than that which results from a routine episiotomy, if it affects the levator ani muscle. A published study on the correlation between episiotomy or perineal tears and pelvic disorders in women who had delivered vaginally 5 to 10 years earlier, concluded that perineal tear was a risk factor for pelvic floor dysfunction but that episiotomy was not (12). Only a small percentage of primiparous women will have an intact perineum after vaginal delivery. There is no data that analyzes the association between episiotomy and mild perineal trauma in primiparous women with spontaneous vaginal delivery. Knowing whether or not an association exists and being able to analyze the risk factors associated with mild perineal tears, would help us reach a better understanding of the appropriate use of episiotomy. The study aimed to estimate the incidence of different types of perineal tears [as classified by the Royal College of Obstetricians (13)] in a group of primiparous women with spontaneous vaginal delivery and to identify factors that could be associated with the presence of second degree perineal trauma. Materials and MethodsThis study is a subset analysis of women who had spontaneous vaginal deliveries from an institutional review Abstract Objectives: To estimate the incidence of perineal trauma in primiparous women with spontaneous vaginal delivery and to identify the factors associated with second-degree lacerations. Materials and Methods: A subset analysis of women with spontaneous vaginal deliveries (n=489) from an institutional review board-approved parent study in healthy, nulliparous, continent pregnant women, attending the public health care system of Catalonia (northeast Spain). Primary outcome measure was perineal trauma according to the RCOG classification. For the bivariate analysis, the Student's t-test, ANOVA and the chi-squared test, or the corresponding non-parametric tests were used. Rat...

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“…Although it has been shown that forceps delivery had higher successful rate of instrumental delivery than ventouse delivery,[ 30 ] this benefit have to balance against the increase risk of maternal OASIS and subsequent morbidities. In fact, a report from Bulgaria[ 31 ] did show that the usage rate of forceps delivery was dropped from >2% to <1% in a decade. This indicates that obstetricians nowadays prefer ventouse rather than forceps in nonspecific indications of instrumental delivery.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Obstetric Anal Sphincter Injuries after Various Modes of Vaginal Deliveries in Chinese Women

Tung

Cheon

Tong

et al. 2015

Chinese Medical Journal

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Background:Obstetric anal sphincter injuries (OASIS) can cause an adverse impact on women's physical and mental health. There was lack of published data in Chinese population particularly on studying the risk of OASIS for nonrotational outlet forceps. This study was to determine the incidence and risk factors of OASIS.Methods:This is a retrospective cohort study carried out in a tertiary referral hospital in Hong Kong. The control group was selected randomly. Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS. This study reviewed the obstetric records of OASIS women and random control from January 2011 to June 2014. Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS.Results:Of 15,446 women delivered, 49 had OASIS. The percentage of OASIS increased from 0.3% (2011) to 0.38% (2014). There was an increasing trend of OASIS in attempted spontaneous vaginal delivery without episiotomy (P < 0.01), but it did not increase the OASIS risk (P = 0.46). Univariate analysis of 49 cases and 438 control subjects showed that forceps delivery (odds ratio [OR] =8.73, P < 0.01), prolong second stage of labor (OR = 1.43, P < 0.01) increased the risk for OASIS. In multivariate regression models, only forceps delivery (OR = 6.28, P < 0.01) proved to be independent risk factor.Conclusions:The incidence of OASIS in Chinese women was increased after 2012, but still lower than the reported figures in the literature. Outlet forceps delivery could be a possible associated risk factor.

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Factors Associated With Perineal Lacerations Requiring Suture in Vaginal Births Without Episiotomy

Cited by 11 publications

References 0 publications

Episiotomy and its relationship to various clinical variables that influence its performance

Episiotomy and its relationship to various clinical variables that influence its performance

Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

Incidence and Risk Factors of Obstetric Anal Sphincter Injuries after Various Modes of Vaginal Deliveries in Chinese Women

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