Risk Factors in Third and Fourth Degree Perineal Tears in Women in a Tertiary Centre: An Observational Ambispective Cohort Study

Abstract

Objectives: To analyze the main risk factors associated with third and fourth degree postpartum perineal tears in women attended to in our obstetrics service. Methods: An observational, retrospective, hospital cohort study was carried out in women whose deliveries were attended to in the obstetrics service of the Hospital General Universitario Gregorio Marañón de Madrid (HGUGM), during the period from January 2010 to April 2017. Results: During the study period, a total of 33,026 patients were included in the study. For maternal variables, the associated increased risk of severe perineal tearing in nulliparous women is OR = 3.48, for induced labor OR = 1.29, and for instrumental delivery by forceps OR = 4.52 or spatulas OR = 4.35; for the obstetric variable of episiotomy, it is OR = 3.41. For the neonatal variables, the weight of the newborns has a directly proportional relationship with the risk of severe tears, and for birth weights of 3000 g (OR = 2.41), 3500 g (OR = 1.97), and 4000 g (OR = 2.17), statistically significant differences were found in each of the groups (p < 0.05). Conclusion: Primiparity, induction of labor, episiotomy, instrumental delivery with forceps or spatula, and a birth weight of 3000 g or more are significantly associated with an increased risk of third and fourth degree perineal tears.

Treatment of Dyspareunia with Botulinum Neurotoxin Type A: Clinical Improvement and Influence of Patients’ Characteristics

“…According to the literature, perineal tears during vaginal delivery are mainly first or second-degree, while incidence rates of third and fourth-degree (more severe) traumas are 3.3% and 1.1%, respectively [27]. However, patients with a third-degree perineal tear represented almost 30% of the total in the present study, suggesting that these more severe perineal tears could be a risk factor for CPP, as some authors have previously pointed out [28]. Despite the severity of this obstetric trauma, the patients with a third-degree perineal tear showed a similar improvement to that of patients without a tear after BoNT/A infiltration.…”

Incidencia, complicaciones inmediatas y tempranas de desgarros perineales graves durante el parto en una institución de referencia de atención obstétrica en Medellín, Colombia

“…Se aprecia una incidencia de DPS mucho menor a la esperada, comparada con lo reportado en la literatura (4). En Europa se ha reportado una frecuencia de estos desgarros entre el 2,1 % y el 8,3 % en un número similar de partos (1,4). En Latinoamérica la incidencia es menor, entre el 0,3 % y el 2,2 % (10).…”

“…La ocurrencia de desgarros perineales severos (DPS) se ha descrito hasta en el 8,3 % de los partos, comprometiendo el esfínter anal, con o sin compromiso de la mucosa rectal (1). De acuerdo con la severidad y compromiso de las estructuras anatómicas, los desgarros perineales se consideran severos cuando son de tercer y cuarto grado según la clasificación más aceptada, y se conocen también como OASIS (por sus siglas en inglés, Obstetric Anal Sphincter Injuries) (2,3,4).…”

“…Los DPS se presentan durante la ampliación máxima del periné en la tercera fase del trabajo de parto. Se han descrito algunos factores de riesgo maternos y fetales que propician su ocurrencia (4,5); entre los primeros, relacionados con la madre, se cuentan la nuliparidad, el bajo peso materno, la edad gestacional superior a 37 semanas y el expulsivo prolongado. Entre los segundos, relacionados con el feto, se destacan el peso mayor a 3500 g, la distocia de hombros y un mayor perímetro cefálico.…”

Validation and Psychometric Properties of the Spanish Version of the Fear of Childbirth Questionnaire (CFQ-e)

“…Based on the latter, item 19 was removed from the final CFQ-e model, although we recommend assessing this aspect in future studies on the CFQ-e. In Spain, episiotomy rates are even higher than the recommended number [ 53 , 54 , 55 ], suggesting that Spanish women are still insufficiently aware of certain childbirth interventions, and this could influence FOC.…”