Incidence and risk factors of third- and fourth-degree perineal tears in a single Italian scenario

Frigerio, Matteo; Manodoro, Stefano; Bernasconi, Davide Paolo; Verri, Debora; Milani, Rodolfo; Vergani, Patrizia

doi:10.1016/j.ejogrb.2017.12.042

Cited by 25 publications

(34 citation statements)

References 24 publications

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“…[11] One study investigated third and fourth degree tears in an Italian population and found moderate / severe obesity was associated with such injuries. [33] However, we found no association with increasing BMI and the risk of repeat third or fourth degree tear. Interestingly, we found that more women with an initial third- or fourth-degree tear but no repeat third- or fourth-degree tear in the second vaginal birth had a forceps delivery in the second birth compared to cases (3.4% versus 2.7% respectively).…”

Section: Discussioncontrasting

confidence: 62%

“…Episiotomy use[34] and specifically restrictive episiotomy use[35], as well as episiotomy use at vacuum deliveries[36,37] have been associated with a reduction in risk of third and fourth degree tears in observational studies. However, evidence is conflicting with others reporting episiotomy has no effect on risk of third or fourth degree tear[33,38] or that episiotomy increases the risk of risk of third or fourth degree tear. [39] Episiotomy increased the risk of third or fourth degree tear when performed at instrumental deliveries in an observational study but was protective at spontaneous vaginal births,[40] which suggests that the increased risk could be secondary to instrumental vaginal birth as opposed to episiotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Predicting women at higher risk of third or fourth degree tears has been studied in the past. [33,45] An effective prediction model to identify women at higher risk of first third or fourth degree tear and to predict those with an initial injury who are at increased risk for a repeat injury would be ideal to help aid decision-making for women. Furthermore, qualitative research is needed to explore women’s views after enduring a third- or fourth-degree tear and to determine their priorities for subsequent births.…”

Section: Discussionmentioning

confidence: 99%

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The impact of third- or fourth-degree perineal tears on the second pregnancy: A cohort study of 182,445 Scottish women

et al. 2019

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This study aimed to investigate the reproductive impact of a third- or fourth-degree tear in primigravid women. A retrospective population-based cohort study was conducted using data from Scottish Morbidity Records (SMR02). Primigravid women with a vaginal birth in Scotland from 1997 until 2010 were included. Exposure was third- or fourth-degree tear in the first pregnancy. The second pregnancy rate, interpregnancy interval and third- or fourth-degree tear in a second pregnancy were the primary outcomes. A nested case-control study was used to determine factors associated with repeat third- or fourth-degree tears in a second vaginal birth. Cox regression analysis and logistic regression were used to look for associations. Initial third- or fourth-degree tear occurred in 2.8% women (5174/182445). The percentage of third- or fourth-degree tears in first vaginal births increased from 1% in 1997 to 4.9% in 2010. There was no difference in having a second pregnancy (adjusted Odds Ratio (aOR) 0.98 (99%CI 0.89–1.09)) or the median interpregnancy interval to second pregnancy (adjusted Hazard Ratio (aHR) 1.01 (99%CI 0.95–1.08)) after an initial third- or fourth-degree tear. Women were over four times more likely to have a repeat injury in a subsequent vaginal birth (n = 149/333, aOR 4.68 (99% 3.52–6.23)) and were significantly more likely to have an elective caesarean section in their second pregnancy (n = 887/3333, 26.6%; 12.75 (11.29–14.40)). Increased maternal age and birthweight ≥4500g were risk factors for repeat injury. Third- and fourth-degree tears are increasing in Scotland. Women do not delay or avoid childbirth after initial third- or fourth-degree tear. However, women are more likely to have a repeat third- or fourth-degree tear or an elective caesarean section in the second pregnancy. Strategies to prevent third- or fourth-degree tears are needed.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The impact of third- or fourth-degree perineal tears on the second pregnancy: A cohort study of 182,445 Scottish women

et al. 2019

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“…Certain maternal positions can even be applied to deal with obstetric complications [17,18]. Conversely, if adopting an unfavorable position, women might suffer from a series of negative outcomes, such as severe perineal trauma [[19], [20], [21]], post-partum urinary incontinence [22] and greater blood loss [14,23]. The fetus or newborn is also faced with increased risk of complications [14].…”

Section: Introductionmentioning

confidence: 99%

A review and comparison of common maternal positions during the second-stage of labor

Huang

Zang

Ren

et al. 2019

International Journal of Nursing Sciences

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The second-stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth. Midwives play a pivotal role in managing maternal positions during the second-stage of labor. However, there is limited evidence to support an ideal maternal position during the second-stage of labor. Further, the difference between different maternal positions might not be apparent. This paper aims to review and compare the benefits and risks of common maternal positions during the second-stage of labor, thereby to provide midwives evidence-based practical guidelines.

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“…The possible reason is that we excluded lithotomy, dorsal and Trendelenburg's positions in the control group, which is the major difference between our study and earlier systematic reviews. Many studies indicate that lithotomy, Trendelenburg's and dorsal positions have negative effects on birth outcomes, such as associated with an increased risk of assisted birth (Walker et al., 2012), severe perineal trauma (Elvander et al., 2015; Frigerio et al., 2018) and episiotomy (Warmink‐Perdijk et al., 2016; Zhang et al., 2017). Excluding these harmful positions in the control group could avoid the overestimation of the effects of upright positions.…”

Section: Discussionmentioning

confidence: 99%

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

Zang

Zhang

et al. 2020

Journal of Advanced Nursing

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Aims To assess the effects of upright positions on maternal outcomes for women without epidural analgesia in comparison with recumbent positions during the second stage of labour. Background Upright positions have many physiological advantages. The underlying benefits and risks of upright positions during the second stage of labour have been reported in many studies but the results are divergent. Design A meta‐analysis of randomized controlled trials. Data sources The Cochrane Library, PubMed, Embase, CINAHL and ProQuest databases were systematically searched from inception to 17 June 2019. Review methods We conducted the quality appraisal using the Cochrane Collaboration's tool and performed meta‐analyses using the Review Manager 5.3 software. The primary outcomes were instrumental vaginal delivery and the duration of the second stage of labour. Results Overall, 12 studies including 4,314 women were included. Upright positions significantly decreased the rate of instrumental vaginal delivery (risk ratio [RR] = 0.74, 95% CI 0.59–0.93), shortened the active pushing phase (mean difference [MD] = −8.16 min, 95% CI −16.29 to −0.02), decreased the rate of severe perineal trauma (RR = 0.35, 95% CI 0.14–0.87) and episiotomy (RR = 0.52, 95% CI 0.29–0.92), but significantly increased the rate of second‐degree perineal trauma (RR = 1.45, 95% CI 1.10–1.90). However, there was no significant difference in the duration of the second stage of labour or postpartum haemorrhage. Conclusions Upright positions are beneficial for improving maternal outcomes. Several results should be considered with caution. Researchers need to clarify the definition of upright positions and conduct large, robust studies in the future to provide stronger evidence. Impact This meta‐analysis explores a crucial issue in intrapartum care and clarifies the benefits and possible risks of upright positions in the second stage of labour. Midwives and obstetricians are encouraged to apply upright positions depending on women's preferences and labour progress but should take measures to prevent perineal trauma.

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Incidence and risk factors of third- and fourth-degree perineal tears in a single Italian scenario

Cited by 25 publications

References 24 publications

The impact of third- or fourth-degree perineal tears on the second pregnancy: A cohort study of 182,445 Scottish women

The impact of third- or fourth-degree perineal tears on the second pregnancy: A cohort study of 182,445 Scottish women

A review and comparison of common maternal positions during the second-stage of labor

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

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