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

Abstract

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 (

Factors associated with anal sphincter laceration in 40,923 primiparous women

“…Epidural analgesia, inaugurated by Fidel Pages in 1921 and increasingly used in obstetrics since the 1980s, has come more and more under scrutiny for its role in anal sphincter laceration, specifically for allegedly increasing duration of second stage labor and increasing risk of operative delivery; it has also been linked to an increased C/S rate and increased fetal malposition [24,[33][34][35][36][37]. Indeed, our cross table analysis seemed to confirm those allegations; however, when subjected to multiple logistic regression analysis and when controlled for by other forms of analgesia, we actually found a beneficial effect on anal sphincter laceration.…”

The incidence of obstetric anal sphincter rupture in primiparous women: a comparison between two European delivery settings

“…Concerning EDA, significant association with extensive perineal trauma has been shown (7). Most studies, however, do not show a significant association with OASR after adjusting for factors, such as instrumental delivery, prolonged second stage and episiotomy (5,11,12) or even a protective effect (6).…”

Does Epidural Analgesia Affect the Rate of Spontaneous Obstetric Lacerations in Normal Births?

“…Epidurals have been associated with a higher rate of serious perineal lacerations 4 . However, this observation is confounded by the increased use of episiotomy and vaginal operative procedures in women with epidurals, both of which are recognized as primary risk factors for severe perineal injury 2,4,8 …”

“…4 However, this observation is confounded by the increased use of episiotomy and vaginal operative procedures in women with epi-durals, both of which are recognized as primary risk factors for severe perineal injury. 2,4,8 Recent studies have compared the rates of third-and fourth-degree lacerations in women with and without labor epidurals, and used multivariable techniques to adjust for relevant maternal and clinical variables. Multivariable adjustment is important because primigravidas are more likely to use labor epidurals and they sustain more lacerations during childbirth than multiparous women.…”