Perineal Body Length and Perineal Lacerations During Delivery in Primigravid Patients

Abstract

This study assessed the relation between perineal body length and the risk of perineal laceration extending into the anal sphincter during vaginal delivery in primigravid patients at an institution with a low utilization of episiotomy. This was a prospective study of primigravid patients in active labor. Primigravid women with singleton pregnancies who were in the first stage of labor at 37 weeks gestation or greater were recruited, and the admitting physician measured the length of the perineal body. The degree of perineal laceration and other delivery characteristics were recorded. Data were analyzed using univariate analyses, receiver-operator curve analyses, and multiple logistic regression for factors associated with increased severity of vaginal lacerations. The perineal body length, duration of second stage of labor, type of delivery, and patient age were associated ( < 0.1) with third- and fourth-degree (severe) perineal lacerations in primigravid women using receiver-operator curve analysis. Using logistic regression, only the duration of second stage of labor and length of the perineal body were significant ( < 0.04) predictors of third- and fourth-degree lacerations, with odds ratios of 32 (1.3 to 807 as 95% CI) and 24 (1.3 to 456), respectively. Both a perineal body length of ≤3.5 cm and a duration of second stage of labor >99 minutes were associated with an increased risk of third- and fourth-degree lacerations in primigravid patients.

The Female Pelvic Floor Fascia Anatomy: A Systematic Search and Review

“…Ten studies [ 55 , 62 , 65 , 68 , 71 , 73 , 74 , 75 , 76 ] assessed the anatomy of the PB in a total of 604 females (485 living and 119 cadavers) aged between 15 and 104 years of age. Two studies [ 55 , 75 ] used a dissection approach, one [ 76 ] used a histological approach only, two [ 62 , 65 ] combined dissection and histology, one [ 68 ] employed MRI, one [ 73 ] performed ultrasound imaging, and three [ 73 , 76 , 81 ] utilized clinical morphometrical measurements to describe the PB.…”

“…The mean PB length assessed in young primigravid Cameroonian women at 36 weeks of pregnancy was 3.21 cm (SD 0.75; range 1.5–5.5). Measured during the first stage of labor in primigravid women, the mean PB length obtained was 3.7 cm (SD 0.5; range 2.3–5.0) [ 74 ] and 3.9 cm (95%CI: 3.8–4.0; range 2.2–6.0 cm) [ 71 ] in samples mainly from Caucasian women and multiracial women, respectively. In a study using a dissection approach in older embalmed cadavers, a smaller length was measured, ranging from 1 cm to 2 cm [ 62 ].…”

“…Three studies [ 16 , 36 , 74 ] assessed the anatomy of the pubocervical fascia in a total of 111 female cadavers ranging in age from 26 to 104 years. Although all studies used dissection, Hinata, et al [ 72 ] also used a histological approach.…”

“…Eight studies [ 12 , 16 , 20 , 21 , 36 , 60 , 74 , 79 ] involving a total of 250 females (102 living and 148 cadavers) investigated the anatomy of the RVF. The age range across studies was 15–104 years.…”

Rate of Episiotomy And Perineal Injuries during Vaginal Delivaries at Maternity Hospital in Duhok City

“…Tears, described by Fernando who divided them into four degrees, most frequently involve perineal skin and mucosa (1st degree), they may extend to perineal muscle (2nd degree), anal sphincter complex (3rd degree), and anal mucosa (4th degree) (Lane et al, 2017:Fernando et al, 2015.…”