Characteristics Associated With Severe Perineal and Cervical Lacerations During Vaginal Delivery

Abstract

Objective To characterize potentially modifiable risk factors for third- or fourth-degree perineal lacerations and cervical lacerations in a contemporary U.S. obstetric practice. Methods The Consortium on Safe Labor collected electronic medical records from 19 hospitals within 12 institutions (228,668 deliveries from 2002 to 2008). Information on patient characteristics, prenatal complications, labor and delivery data, and maternal and neonatal outcomes were collected. Only women with successful vaginal deliveries of cephalic singletons at 34 weeks of gestation or later were included; we excluded data from sites lacking information about lacerations at delivery and deliveries complicated by shoulder dystocia; 87,267 and 71,170 women were analyzed for third- or fourth-degree and cervical lacerations, respectively. Multivariable logistic regressions were used to adjust for other factors. Results Third- or fourth-degree lacerations occurred in 2,516 women (2,223 nulliparous [5.8%], 293 [0.6%] multiparous) and cervical lacerations occurred in 536 women (324 nulliparous [1.1%], 212 multiparous [0.5%]). Risks for third or fourth-degree lacerations included nulliparity (7.2-fold risk), being Asian or Pacific Islander, increasing birth weight, operative vaginal delivery, episiotomy, and longer second stage of labor. Increasing body mass index was associated with fewer lacerations. Risk factors for cervical lacerations included young maternal age, vacuum vaginal delivery, and oxytocin use among multiparous women, and cerclage regardless of parity. Conclusion Our large cohort of women with severe obstetric lacerations reflects contemporary obstetric practices. Nulliparity and episiotomy use are important risk factors for third- or fourth-degree lacerations. Cerclage increases the risk for cervical lacerations. Many identified risk factors may not be modifiable.

Association between perineal trauma and pain in primiparous women

“…The high frequency of pain and perineal trauma identified in this study strengthens the evidence that primiparity predisposes women to trauma (5,(15)(16) and perineal pain after childbirth (17) .…”

Current approach to episiotomy: Inevitable or unnecessary?

“…Severe lacerations (third or fourth degree) occurred in 4.8% of women with history of episiotomy at first delivery compared with 1.7% without history of episiotomy. This finding should take place in the obstetric practice meaning that we should respect the indications for usage of episiotomy [22,23]. But there is a need to highlight that the mediolateral episiotomy may be also a prophylactic measure against three and four degree lacerations [24].…”

Biocompatibility of a Sonicated Silk Gel for Cervical Injection During Pregnancy: In Vivo and In Vitro Study

“…18,19 In addition, cerclage can cause complications such as bleeding, rupture of membranes, and cervical trauma. 20 In populations tested to date, neither progesterone nor cerclage is effective in women with multiple gestations. 21,22 These limitations have prompted the call for new therapies to prevent preterm birth.…”