Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study

Simić, Marija; Cnattingius, Sven; Petersson, Gunilla; Sandström, Anna; Stephansson, Olof

doi:10.1186/s12884-017-1251-6

Cited by 80 publications

(86 citation statements)

References 27 publications

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“…[9][10][11][12] Many studies showed multiparity as a protective factor against perineal tears and a higher incidence of intact perineum. [13][14][15] Women in this study were mainly in their first pregnancy; however, after the multiple analysis, the chance of spontaneous perineal tear decreased for each previous vaginal childbirth.…”

Section: Discussionmentioning

confidence: 75%

Perineal Care and Outcomes in a Birth Center

Lopes

Leister

Riesco

2019

Texto contexto - enferm.

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Objective: to analyse the perineal outcomes in childbirth and post-partum perineal care in a freestanding birth centre. Method: a cross-sectional study, with data collection performed in the women’s birth records forms from Casa Angela, a freestanding birth centre, São Paulo, Brazil, in 2016-2017 (n=415). The following data was analysed: occurrence and perineal tear degree; maternal, neonatal and birth care-related variables; perineal suture prevalence; complications in wound healing and natural methods on perineal care. Data were subjected to descriptive, inferential and multiple analyses. Results: in 11.8% of women, the perineum was kept intact, 61.9% had spontaneous first-degree tear and 26.3% had second-degree tear. The variables related to the occurrence and higher spontaneous degree tears were maternal age and second period of childbirth >2 hours. The protective factors against the occurrence and higher degree tears were number of previous vaginal childbirths and maternal position different from vertical during childbirth. Perineal suture was performed in 16.0% and 70.6% of women with spontaneous first- and second-degree tears, respectively. The main perineal complications after birth were edema (53.6%) and pain (29.4%); and the perineal suture increased the chance for these complications (OR=2.5; 95%CI 1.5-4.3). Perineum icepack compress was used in 53.8% of women during post-partum period. Conclusion: maternal and health-care related factors were associated to the prevalence and degree of spontaneous perineal tear. First-degree spontaneous perineal tears were prevalent and sutured in a low number of women. There were more complications in the wound healing process when the perineal suture was performed, regardless the tear degree. The number of natural methods in post-partum perineal care was higher than the use of medicines.

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Section: Discussionmentioning

confidence: 75%

Perineal Care and Outcomes in a Birth Center

Lopes

Leister

Riesco

2019

Texto contexto - enferm.

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“…We observed that residents were more exposed to VEs during night shifts, but this did not influence the risk of OASIS. It was also more common for residents to handle VE after prolonged pushing, which may increase the risk of OASIS . However, the observed association between resident operators and OASIS actually increased after adjusting for this and other possible confounders.…”

Section: Discussionmentioning

confidence: 92%

“…Several studies have examined risk factors for OASIS in spontaneous and operative vaginal deliveries . Few studies have investigated operator‐related risk factors associated with OASIS in VE .…”

Section: Discussionmentioning

confidence: 99%

“…Among them, the rate of OASIS is even higher, making operative vaginal delivery the single most important risk factor for OASIS . Other risk factors for OASIS are nulliparity, high birthweight, occiput posterior position, prolonged second stage, prolonged pushing, and being of African or Asian origin . Studies focusing on risk factors for OASIS specific for operative vaginal deliveries have reached similar results .…”

Section: Introductionmentioning

confidence: 93%

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Operator experience affects the risk of obstetric anal sphincter injury in vacuum extraction deliveries

Bergendahl

Lindberg

Wendel

2019

Acta Obstet Gynecol Scand

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Introduction: Delivery by vacuum extraction is a major risk factor for obstetric anal sphincter injury. The aim of this study was to assess risk factors for obstetric anal sphincter injury in vacuum extraction in nulliparous women, specifically operator-related factors. A secondary aim was to assess other complications of vacuum extraction that are dependent on operator experience. Material and methods:A historical cohort study of nulliparous women with a live single fetus ≥34 weeks, delivered by vacuum extraction at a teaching hospital in Sweden in 1 year (2013), using data from medical records. Risk of obstetric anal sphincter injury was assessed for obstetricians (reference), gynecologists, and residents, and adjusted for maternal, fetal, procedure-related, and operator-related covariates using unconditional logistic regression. Results are presented as prevalence and crude and adjusted odds ratio (aOR) with 95% CI. Results:In total, 323 nulliparous women delivered by vacuum extraction were included. Obstetric anal sphincter injury occurred in 57 (17.6%) women. Fifteen (11.5%) obstetric anal sphincter injuries occurred in vacuum extractions performed by obstetricians, 10 (13.5%) by gynecologists (aOR 1.84, 95% CI 0.72-4.70), and 32 (26.9%) by residents (aOR 5.13, 95% CI 2.20-11.95). Maternal height ≤155 cm (aOR 4.63, 95% CI 1.35-15.9) and conversion to forceps (aOR 19.4, 95% CI 1.50-252) increased the risk of obstetric anal sphincter injury. Operator gender, night shift work, or being a frequent operator did not affect the risk of obstetric anal sphincter injury. Postpartum hemorrhage and fetal complications did not differ between operator categories. Conclusions:The adjusted risk of obstetric anal sphincter injury in nulliparous women was five times higher in vacuum extractions performed by residents compared with those performed by obstetricians. Vacuum extractions performed by gynecologists did not carry an increased risk of obstetric anal sphincter injury. Experience in years of training, rather than frequency of the procedure, seemed to have the highest impact on reducing obstetric anal sphincter injury in vacuum extractions, which indicates a need for increased training and supervision. K E Y W O R D Snulliparous, obstetric anal sphincter injury, operative vaginal delivery, training in obstetrics, vacuum extraction

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“…Table 2. Summary of described risk factors for obstetric anal sphincter injuries (15,(21)(22)(23)(24)(25)(26)(27)(28). OASIS -obstetric anal sphincter injuries.…”

Section: Risk Factors For Third-degree Perineal Lacerationsmentioning

confidence: 99%

Clinical and methodological aspects on perineal laceration diagnostics at childbirth

Pihl

2020

Linköping University Medical Dissertations

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When compared to the hands the sphincter ani is far superior. If you place into your cupped hands a mixture of fluid, solid and gas and then, through an opening at the bottom try to let only the gas escape you will fail. Yet the sphincter ani can do it. The sphincter apparently can differentiate between solid, fluid, and gas. It apparently can tell whether the owner is alone or with someone, whether standing up or sitting down, whether its owner has his pants on or off. No other muscle in the body is such a protector of the dignity. A muscle like that is worth protecting."

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Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study

Cited by 80 publications

References 27 publications

Perineal Care and Outcomes in a Birth Center

Perineal Care and Outcomes in a Birth Center

Operator experience affects the risk of obstetric anal sphincter injury in vacuum extraction deliveries

Clinical and methodological aspects on perineal laceration diagnostics at childbirth

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