Risk Factors for Third Degree Perineal Ruptures During Delivery

Leeuw, J.W. de; Struijk, P. C.; Vierhout, Mark E.; Wallenburg, Henk C.S.

doi:10.1097/00006254-200110000-00008

Cited by 39 publications

(84 citation statements)

References 13 publications

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“…It may be difficult to prevent these complications. Although there is evidence that a prophylactic mediolateral episiotomy may prevent third-degree perineal tears in a general obstetric population (20), EDS patients may have slow and complicated healing of the episiotomy wound. Also, because of the laxity of the perineal tissue, an episiotomy may even be indicated less often than in nonaffected women.…”

Section: Discussionmentioning

confidence: 98%

Pregnancy and the Ehlers-Danlos syndrome: a retrospective study in a Dutch population

Lind¹,

Wallenburg²

2002

Acta Obstet Gynecol Scand

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Background. The study was carried out to assess the course and outcome of pregnancies in women with the Ehlers-Danlos syndrome, with the aim of developing guidelines for assessment of risk and counseling, and for providing optimum medical and obstetric care. Methods. A retrospective study based on data collected from members of the Dutch Association of Ehlers-Danlos patients. Pregnancies and neonatal outcomes of the affected mothers were compared with those of the nonaffected mothers who delivered an infant with Ehlers-Danlos syndrome.Results. In a group of 46 women with Ehlers-Danlos syndrome, 128 pregnancies beyond 24 weeks gestation were evaluated and compared with 43 pregnancies of 33 nonaffected women. The main maternal complications consisted of pelvic pain and instability (26% vs. 7%). One bowel rupture was reported in a woman with Ehlers-Danlos syndrome type IV. Preterm delivery occurred in 21% of the affected mothers compared with 40% of the nonaffected women with an affected infant; the women with Ehlers-Danlos syndrome experienced postpartum hemorrhage (19% vs. 7%) and complicated perineal wounds (8% vs. 0%) more often than the unaffected women. The floppy infant syndrome was diagnosed in 13% of the affected infants and did not occur in the nonaffected neonates. Conclusion. Pregnancy is generally well-tolerated in women with Ehlers-Danlos syndrome, with favorable maternal and neonatal outcomes. In Ehlers-Danlos syndrome type IV it may be associated with severe maternal complications. Preconceptional counseling concerning specific possible complications and a multidisciplinary approach are recommended.

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Section: Discussionmentioning

confidence: 98%

Pregnancy and the Ehlers-Danlos syndrome: a retrospective study in a Dutch population

Lind¹,

Wallenburg²

2002

Acta Obstet Gynecol Scand

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“…We focused on primiparous women, as earlier studies had concluded that birth order and a perineal tear in an earlier birth are important risk factors. [20][21][22][23][24][25][26] Excluding NHS Trusts with poor data quality may have introduced bias, as the risk-adjusted tear rates at these hospitals may be different from the rates observed in hospitals with better data quality. However, the effect size of selection bias is likely to be small because the distributions of outcome and risk factors in both groups were similar (Table S1).…”

Section: Discussionmentioning

confidence: 99%

“…39 Mode of delivery is a key determinant of the risk of perineal tears, with studies consistently demonstrating that women with instrumental deliveries have higher rates of anal sphincter tears, 2,23,28,37 and that forceps deliveries carry the highest risk of third-or fourth-degree perineal tears. The risk of having a severe perineal injury has been reported to be 1.5-14.0 times higher with forceps, and up to four times higher with ventouse, than with spontaneous vaginal delivery.…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

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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“…However, the number of women (22) in this study delivered by forceps or vacuum extraction is too low to draw any conclusions on the rate of anal sphincter tears in operative vaginal delivery. We do underline, however, the statement of Murphy et al 1 that operative vaginal delivery is associated with an increased risk for anal sphincter injury, 5 but this was not the primary aim of this study.…”

Section: Sirmentioning

confidence: 72%