Racial/ethnic variations in perineal length and association with perineal lacerations: a prospective cohort study

Yeaton-Massey, Amanda; Wong, Luchin; Sparks, Teresa N.; Handler, Stephanie J.; Meyer, M. Renée Umstattd; Granados, Jesus M.; Stasenko, Marina; Sit, Anita; Caughey, Aaron B.

doi:10.3109/14767058.2014.916675

Cited by 20 publications

(11 citation statements)

References 8 publications

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“…When comparing women who sustained rOASI with those who did not, a greater incidence of repeat trauma was seen amongst those of Asian ethnicity. This is in line with other studies that have shown ethnic variation in perineal length, pelvic anatomy and tissue composition and resultant differences in predisposition to birth trauma [7,[13][14][15][16].…”

Section: Discussionsupporting

confidence: 92%

Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study

et al. 2019

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Introduction and hypothesis Women with a history of obstetric anal sphincter injury (OASI) are at increased risk of recurrence (rOASI) at subsequent delivery; however, evidence regarding the factors influencing this risk is limited. Furthermore, little is known about what factors influence the decision to alternatively deliver by elective caesarean section (ELLSCS). Methods Retrospective univariate and multivariate logistic regression analysis of prospectively collected data from four NHS electronic maternity databases including primiparous women sustaining OASIS during a singleton, term, cephalic, vaginal delivery between 2004 and 2015, who had a subsequent delivery. Results Two thousand two hundred seventy-two women met the criteria; 10.2% delivering vaginally had a repeat OASI and 59.4% had a second-degree tear. Women having an ELLSCS were more likely to be Caucasian, older, have previously had an operative vaginal delivery (OVD) and have a more severe degree of OASI. Positive predictors for rOASI were increased birth weight and maternal age at both index and subsequent deliveries, a more severe degree of initial OASI and Asian ethnicity. The overall mediolateral episiotomy (MLE) rate was 15.6%; 77.2% of those who had an episiotomy sustained no spontaneous perineal trauma. Only 4.4% of women with a rOASI had an MLE, whilst the MLE rate was 16.9% in those without a recurrence (p < 0.001). MLE decreased the risk of rOASI by 80%. Birth weight > 4 kg increased the risk 2.5 fold. Conclusions Women with previous OASIS are at an increased risk of recurrence. A more liberal use of MLE during subsequent vaginal delivery could significantly reduce the risk of recurrence.

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Section: Discussionsupporting

confidence: 92%

Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study

et al. 2019

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“…Possible factors that may contribute to the increased risk of maternal death in certain populations include a higher prevalence of cardiovascular diseases and obesity as well as poorer management of maternal health [ 31 ]. Differences in the proportion of perineal lacerations [ 32 ], use of tobacco and alcohol [ 33 ], gestational diabetes [ 34 ], type of anaesthesia used during caesarean [ 35 ] and ectopic pregnancy [ 36 ] have also been observed when comparing groups by maternal origin.…”

Section: Discussionmentioning

confidence: 99%

Maternal mortality in Spain and its association with country of origin: cross-sectional study during the period 1999–2015

et al. 2018

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BackgroundThe available literature suggests that there are significant differences in maternal mortality according to maternal origin in high income countries. The objective of this study was to quantify the risk of maternal death by maternal origin and region of Spain where the birth occurred and to identify the most important causes of maternal death in our country.MethodsAn ecological cross-sectional study was conducted that included all deliveries that resulted in maternal survival and cases of maternal death during 1999–2015 in Spain. A descriptive analysis of the maternal mortality rate by maternal origin, region and year of birth was performed. The risk of maternal death was calculated using univariate and multivariate logistic regression analysis, with adjustment for the variables included in the descriptive analysis.ResultsThere were 272 maternal deaths during this period, most of which were due to haemorrhage (63 cases, 23.16%).Women whose continent of origin was South America had the highest adjusted risk of maternal death, with an OR of 3.92 (95% CI 2.75–5.58). The region of Spain with the highest risk of maternal death was Ceuta, with an OR of 12.11 (95% CI 2.02–72.68).ConclusionsThis study shows that there are inequalities in maternal mortality according to maternal origin and region where labour occurred. These findings highlight the need to establish strategies at the national and European levels to analyse the most relevant causes and risk factors associated with maternal mortality in order to reduce it and pay closer attention in identifying and carefully managing pregnant women from this at risk groups.

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“…Some have proposed that there exist racial difference in perineal body length, with shorter perineums being more likely to experience severe lacerations [9]. One multicenter study [10] discounted this theory by showing no statistical difference in perineal length between races and no association between perineal length and severe lacerations. The same study did demonstrate that Asian race remains an independent risk factor regardless of perineal length.…”

Section: Discussionmentioning

confidence: 96%

Are Asian American women at higher risk of severe perineal lacerations?

Quist‐Nelson

Parker

Berghella

et al. 2016

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective: To evaluate whether Asian race is an independent risk factor for severe perineal lacerations. Methods: We performed a nationwide population-based retrospective cohort study examining the relationship between Asian race and severe perineal lacerations (third and fourth degree). The data were collected from the 2012 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). Characteristics of Asian American women were compared with those of non-Asian women. The primary outcome of interest was severe perineal lacerations. Multivariable logistic regression was used to refine the associations between Asian race and severe perineal lacerations while adjusting for confounding effects. Results were compared with previously published data using a pooled odds ratio. Results: 2,270,044 Women with singleton vaginal deliveries were identified, and 120,452 (5.3%) were Asian. After adjusting for confounders, Asian women were more likely to experience severe perineal lacerations than any other racial group (3.5% versus 6.3%, adjusted odds ratio [aOR] 1.50, 99% CI 1.29-1.74, p50.0001). Analysis of literature indicated that Asian American women are 74% more likely to experience severe perineal lacerations (aOR 1.74, 99% CI 1.72-1.76, p50.0001) than non-Asians. Conclusion: Asian race is an independent risk factor for severe perineal lacerations in the United States.

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Racial/ethnic variations in perineal length and association with perineal lacerations: a prospective cohort study

Cited by 20 publications

References 8 publications

Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study

Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study

Maternal mortality in Spain and its association with country of origin: cross-sectional study during the period 1999–2015

Are Asian American women at higher risk of severe perineal lacerations?

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