Modifiable and non-modifiable risk factors for obstetric anal sphincter injury in a Norwegian Region: a case–control study

Abstract

Background Obstetric anal sphincter injury (OASI) is a common and severe complication of vaginal delivery and may have short- and long-term consequences, including anal incontinence, sexual dysfunction and reduced quality of life. The rate of OASI varies substantially between studies and national birth statistics, and a recent meta-analysis concluded that there is a need to identify unrecognized risk factors. Our aim was therefore to explore both potential modifiable and non-modifiable risk factors for OASI. Methods We performed a case–control study in a single center maternity clinic in South-Eastern Norway. Data were extracted retrospectively from an institutional birth registry. The main outcome measure was the occurrence of the woman’s first-time 3rd or 4th degree perineal lesion (OASI) following singleton vaginal birth after 30 weeks’ gestation. For each woman with OASI the first subsequent vaginal singleton delivery matched for parity was elected as control. The study population included 421 women with OASI and 421 matched controls who gave birth during 1990–2002. Potential risk factors for OASI were assessed by conditional logistic regression analyses. Results The mean incidence of OASI was 3.4% of vaginal deliveries, but it increased from 1.9% to 5.8% during the study period. In the final multivariate regression model, higher maternal age and birthweight for primiparous women, and higher birthweight for the multiparous women, were the only non-modifiable variables associated with OASI. Amniotomy was the strongest modifiable risk factor for OASI in both primi- (odds ratio [OR] 4.84; 95% confidence interval [CI] 2.60–9.02) and multiparous (OR 3.76; 95% CI 1.45–9.76) women, followed by augmentation with oxytocin (primiparous: OR 1.63; 95% CI 1.08–2.46, multiparous: OR 3.70; 95% CI 1.79–7.67). Vacuum extraction and forceps delivery were only significant risk factors in primiparous women (vacuum: OR 1.91; 95% CI 1.03–3.57, forceps: OR 2.37; 95% CI 1.14–4.92), and episiotomy in multiparous women (OR 2.64; 95% CI 1.36–5.14). Conclusions Amniotomy may be an unrecognized independent modifiable risk factor for OASI and should be further investigated for its potential role in preventive strategies.

Effects of oxytocin induction on early postpartum hemorrhage, perineal integrity, and breastfeeding: a case–control study

“…Santos et al 9 in their study with nulliparous women, determined that there was a significant relationship between the use of SynOT induction and perineal trauma. Similarly, Klokk et al 13 reported that augmentation with oxytocin is an independent risk factor for obstetric anal sphincter injury in primiparous and multiparous women. Despite these findings, Oliveira et al 7 in a retrospective study conducted in a public hospital, reported that no significant relationship exists between SynOT and spontaneous perineal lacerations.…”

“…In the literature, there are different results of studies on the effects of oxytocin induction on the perineum 7,10,13 . Santos et al 9 in their study with nulliparous women, determined that there was a significant relationship between the use of SynOT induction and perineal trauma.…”

Spontaneous Perineal Trauma during Non-Operative Childbirth—Retrospective Analysis of Perineal Laceration Risk Factors

“…It should be emphasized that in the literature on the subject, there are numerous reports of spontaneous perineal trauma, in particular, severe perineal trauma. Perineal lacerations of the third and fourth degree are the most severe forms of spontaneous perineal trauma, and at the same time, are associated with numerous negative and long-term consequences for women's health [5,9,[13][14][15][16][17][18][19][20][21][22][23][24][25].…”