Risk factors for third-degree and fourth-degree perineal lacerations in forceps and vacuum deliveries

Combs, C. Andrew; Robertson, Patricia A.; Laros, Russell K.

doi:10.1016/s0002-9378(11)90678-4

Cited by 178 publications

(126 citation statements)

References 17 publications

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“…These studies found that mediolateral episiotomy reduced the risk of tears in instrumental vaginal deliveries. 1,46,47 Our findings on shoulder dystocia and birthweight confirms the results of previous studies, which found that shoulder dystocia and birthweights higher than 4000 g double the risk of perineal tears. [20][21][22][23]45,48 An increase in the incidence of these risk factors could contribute to a higher rate of tears.…”

Section: Comparison With Previous Literaturesupporting

confidence: 90%

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Gurol‐Urganci

Cromwell

Edozien

et al. 2013

BJOG

338

270

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Objective To describe the trends of severe perineal tears in England and to investigate to what extent the changes in related risk factors could explain the observed trends.Design A retrospective cohort study of singleton deliveries from a national administrative database.Setting The English National Health Service between 1 April 2000 and 31 March 2012.Population A cohort of 1 035 253 primiparous women who had a singleton, term, cephalic, vaginal birth.Methods Multivariable logistic regression was used to estimate the impact of financial year of birth (labelled by starting year), adjusting for major risk factors.Main outcome measure The rate of third-degree (anal sphincter is torn) or fourth-degree (anal sphincter as well as rectal mucosa are torn) perineal tears.Results The rate of reported third-or fourth-degree perineal tears tripled from 1.8 to 5.9% during the study period. The rate of episiotomy varied between 30 and 36%. An increasing proportion of ventouse deliveries (from 67.8 to 78.6%) and non-instrumental deliveries (from 15.1 to 19.1%) were assisted by an episiotomy. A higher risk of third-or fourth-degree perineal tears was associated with a maternal age above 25 years, instrumental delivery (forceps and ventouse), especially without episiotomy, Asian ethnicity, a more affluent socio-economic status, higher birthweight, and shoulder dystocia.Conclusions Changes in major risk factors are unlikely explanations for the observed increase in the rate of third-or fourth-degree tears. The improved recognition of tears following the implementation of a standardised classification of perineal tears is the most likely explanation.Keywords Episiotomy, instrumental delivery, severe perineal trauma, trends, vaginal delivery.

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Section: Comparison With Previous Literaturesupporting

confidence: 90%

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Gurol‐Urganci

Cromwell

Edozien

et al. 2013

BJOG

338

270

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“…Further, the study concluded that use of epidural analgesia does not appear to be related to the incidence of perineal laceration in a population of nulliparous and multiparous patients. Combs et al 5 agreed with this conclusion in 1990, when their study found no effect of epidural analgesia on severe perineal laceration in a population of 2,832 women having operative deliveries. Finally, the oldest study, by Bickers 7 in 1970, concluded that epidural analgesia was protective for perineal laceration.…”

Section: Discussionmentioning

confidence: 69%

“…Other study variables, such as year of birth, number of pregnancies, number of births, vaginal birth after cesarean section, use of episiotomy, type of analgesia (epidural, local, or none), degree of laceration, specialty of the delivering physician (family physician, obstetrician-gynecologist, or nurse-midwife), birth weight, use of inducing agents, maternal age, and use of instrument aides (vacuum, forceps, or none) were taken from literature review and included in the analysis. 5,6,8,9 Race of the mother was eliminated as a potential confounder by previous studies. 4 Statistical analysis was completed using the SAS software package, version 6.12.…”

Section: Methodsmentioning

confidence: 99%

“…Three studies found epidural analgesia to be either protective or not associated to perineal laceration. [5][6][7] A potential explanation for this result is that epidural analgesia causes the perineal muscles to relax, allowing for a more controlled delivery of the fetal head. Conversely, the three other studies reported that epidural analgesia is associated with higher rates of laceration.…”

mentioning

confidence: 99%

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Epidural Analgesia and Severe Perineal Laceration in a Community-based Obstetric Practice

Carroll

Engelken²,

Mosier³

et al. 2003

The Journal of the American Board of Family Medicine

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Background: This study assessed whether epidural analgesia was an independent risk factor for severe perineal laceration.Methods: A retrospective cohort study analyzed 2,759 patients at St. Francis Regional Medical Center who had vertex, spontaneous or induced, singleton, live, vaginal deliveries of neonates of at least 36 weeks' gestation. Patients with diabetes or severe cardiac disease were excluded. Outcomes measured were third-or fourth-degree perineal lacerations.Results: Overall rate of severe perineal laceration was 6.38% (n ‫؍‬ 176). Epidural analgesia was given to 634 (

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“…Several studies have shown the midline procedure in particular is associated with an increased risk of perineal lacerations [Combs et al, 1990;Shiono et al, 1990;Helwig et al, 1993;Klein et al, 1994], reduces the pelvic £oor strength [Rockner et al, 1991], o¡ers little protection against anal sphincter rupture [Green and Sohoo, 1989;Henriksen et al, 1992], and may therefore result in long-lasting urinary incontinence [Tetzschner et al, 1996].…”

Section: Episiotomymentioning

confidence: 99%

The risk of lower urinary tract symptoms five years after the first delivery*

Viktrup

2001

Neurourology and Urodynamics

111

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The first pregnancy and delivery may result in stress and urge incontinence 5 years later. Women with stress and urge incontinence 3 months after the first delivery have a very high risk of long-lasting symptoms. An episiotomy or a vacuum extraction at the first delivery seems to increase the risk. Subsequent childbearing or surgery seems without significant contribution. Long-lasting urgency, diurnal frequency, or nocturia cannot be predicted from onset during the first pregnancy or puerperium.

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Risk factors for third-degree and fourth-degree perineal lacerations in forceps and vacuum deliveries

Cited by 178 publications

References 17 publications

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Epidural Analgesia and Severe Perineal Laceration in a Community-based Obstetric Practice

The risk of lower urinary tract symptoms five years after the first delivery*

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