Episiotomy and its role in the incidence of perineal lacerations in a maternity center and a tertiary hospital obstetric service

Ls, Wilcox; Dm, Strobino; Baruffi, Gigliola; Dellinger, WS

doi:10.1016/0020-7292(90)90213-5

Cited by 8 publications

(16 citation statements)

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“…The overall risk of third degree ruptures of the perineum in our study, defined as any rupture of the perineum involving anal sphincter muscle, is 1.94%. This incidence is higher than that in some European reports 2,5,13,15 , comparable to that in other studies from the continent 6,14 , but much lower than the incidence reported from the United States 11,12,16,17 .…”

Section: Discussionsupporting

confidence: 45%

“…Previous case–controll studies on risk factors and putative preventive interventions concerned small groups of women or groups with a small number of third degree lacerations, which may limit the significance of the results 11,12 . Other studies dealt with risk factors for third degree perineal ruptures in particular clinical conditions, such as instrumental compared with spontaneous vaginal delivery 13–18 .…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for third degree perineal ruptures during delivery

Leeuw

Struijk

Vierhout

et al. 2001

BJOG

158

155

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Objective To determine risk factors for the occurrence of third degree perineal tears during vaginal delivery.Design A population-based observational study. Population All 284,783 vaginal deliveries in 1994 and 1995 recorded in the Dutch National Obstetric Database were included in the study. Methods Third degree perineal rupture was de®ned as any rupture involving the anal sphincter muscles. Logistic regression analysis was used to assess risk factors.Main outcome measures An overall rate of third degree perineal ruptures of 1.94% was found. High fetal birthweight, long duration of the second stage of delivery and primiparity were associated with an elevated risk of anal sphincter damage. Mediolateral episiotomy appeared to protect strongly against damage to the anal sphincter complex during delivery (OR: 0.21, 95% CI: 0.20±0.23). All types of assisted vaginal delivery were associated with third degree perineal ruptures, with forceps delivery (OR: 3.33, 95%-CI: 2.97±3.74) carrying the largest risk of all assisted vaginal deliveries. Use of forceps combined with other types of assisted vaginal delivery appeared to increase the risk even further. Conclusions Mediolateral episiotomy protects strongly against the occurrence of third degree perineal ruptures and may thus serve as a primary method of prevention of faecal incontinence. Forceps delivery is a stronger risk factor for third degree perineal tears than vacuum extraction. If the obstetric situation permits use of either instrument, the vacuum extractor should be the instrument of choice with respect to the prevention of faecal incontinence.

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Section: Discussionsupporting

confidence: 45%

Section: Introductionmentioning

confidence: 99%

Risk factors for third degree perineal ruptures during delivery

Leeuw

Struijk

Vierhout

et al. 2001

BJOG

158

155

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“…Lack of manual protection or suboptimal visualisation of the perineum and perineal oedema were also significantly associated with the occurrence of anal sphincter tears in both the univariate and multiple logistic regression analysis. The duration of the second stage of labour has previously been reported to be unrelated to sphincter tears 11,18,19 . However, in the paper by Bek and Laurberg 11 there was an association with an unadjusted odds ratio of 4.06 (2.5–6.6) which was adjusted to 1.6 (0.9–2.3) in the multiple logistic regression analysis.…”

Section: Discussionmentioning

confidence: 85%

Anal sphincter tears: prospective study of obstetric risk factors

Samuelsson

Ladfors

Wennerholm

et al. 2000

BJOG

139

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Objective To evaluate intrapartum risk factors for anal sphincter tear.Design A prospective observational study.Setting Delivery unit at the University Hospital in Goteborg, Sweden.Participants 2883 consecutive women delivered vaginally during the period between 1995 and 1997.Information was obtained from patient records and from especially designed protocols which were completed during and after childbirth. Main outcome measuresAnal sphincter (third and fourth degree) tear.Results Anal sphincter tear occurred in 95 of 2883 women (3.3%). Univariate analysis demonstrated that the risk of anal sphincter tear was increased by nulliparity, high infant weight, lack of manual perineal protection, deficient visualisation of perineum, severe perineal oedema, long duration of delivery and especially protracted second phase and bear down, use of oxytocin, episiotomy, vacuum extraction and epidural anaesthesia. After analysis with stepwise logistic regression, reported as odds ratio, 95% confidence interval, the following factors remained independently associated with anal sphincter tear: slight perineal oedema ( Analysis of variance showed that manual perineal protection had a stronger influence on lowering the frequency, and lack of visualisation of perineum and infant weight had a stronger influence on raising the frequency, of anal sphincter tears in nulliparous compared with parous women.Conclusions Perineal oedema, poor ocular surveillance of perineum, deficient perineal protection during delivery, protracted final phase of the second stage, parity and high infant weight all constitute independent risk factors for anal sphincter tear. Such information is essential in order to reduce perineal trauma during childbirth.

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“…They suggest this might be due to increased pressure on the perineum or to inelastic vaginal tissue, which might be responsible for slow progress of labour, hence indicating oxytocin use. Since the duration of the second stage is not associated with anal sphincter tear 16,21 , inelastic vaginal tissue is probably responsible for that finding.…”

Section: Discussionmentioning

confidence: 91%

Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy

Poen

Felt‐Bersma

Dekker

et al. 1997

BJOG

148

100

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Objective To determine risk factors for third degree obstetric perineal tears and to give recommendations for prevention.Design Retrospective case-control study.Setting A teaching hospital in The Netherlands.Participants and methods One hundred and twenty cases of vaginal delivery complicated by third degree perineal tear and 702 uncomplicated vaginal deliveries were compared, with respect to possible risk factors.Results In a multivariate model high birthweight, forceps delivery, induced labour, epidural anaesthesia and parity were risk factors for anal sphincter tear. In addition, mediolateral episiotomy was associated with fewer sphincter injuries. Separate analysis of nulli-and multiparous women demonstrated that high birthweight and epidural anaesthesia (increased risk) and mediolateral episiotomy (decreased risk) were factors associated with anal sphincter tear only in nulliparous women.Conclusions We found several risk factors for anal sphincter tear. Nulliparous women are at higher risk than multiparous women. Mediolateral episiotomy may be sphincter-saving especially in nulliparous women and therefore prevent them from chronic faecal incontinence.

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Episiotomy and its role in the incidence of perineal lacerations in a maternity center and a tertiary hospital obstetric service

Cited by 8 publications

References 0 publications

Risk factors for third degree perineal ruptures during delivery

Risk factors for third degree perineal ruptures during delivery

Anal sphincter tears: prospective study of obstetric risk factors

Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy

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