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

Wilcox, Lynne S.; Strobino, Donna M.; Baruffi, Gigliola; Dellinger, Woodrow S.

doi:10.1016/0002-9378(89)90158-0

Cited by 41 publications

(11 citation statements)

References 9 publications

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“…Like our observations, Green et al (12) and Wilcox e t al (13) found no significant association between the duration of second stage of labor and complete tear. Thus prolonged second-stage labor does not appear to be a risk factor for development of complete tear.…”

Section: Discussionsupporting

confidence: 81%

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Intervention during labor: risk factors associated with complete tear of the anal sphincter

Bek

Laurberg

1992

Acta Obstet Gynecol Scand

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Among 41,200 consecutive deliveries there were 152 cases of complete tear of the anal sphincter (complete tear). In a case-control design, the association between interventions during labor (forceps, vacuum extraction, use of oxytocin and prostaglandins and mediolateral episiotomy) and complete tear, were evaluated by confounder control using multiple logistic regression analysis. Controls chosen were the patients delivering just before and after the index patient with complete tear. Use of Kielland forceps, mediolateral episiotomy, shoulder dystocia and nulliparity were significantly associated with complete tear. Maternal age, presentation in labor, duration of second stage of labor and the indication for instrumental deliveries and episiotomy had no significant association with complete tear.

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Section: Discussionsupporting

confidence: 81%

“…Partial lacerations were included, and the incidence of lacerations was high (13%). Wilcox e t al (13) did not find any association between third-and fourth degree perineal lacerations and birthweight greater than 4000 g, as was the case in this study.…”

Section: Discussionsupporting

confidence: 51%

Intervention during labor: risk factors associated with complete tear of the anal sphincter

Bek

Laurberg

1992

Acta Obstet Gynecol Scand

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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 41 publications

References 9 publications

Intervention during labor: risk factors associated with complete tear of the anal sphincter

Intervention during labor: risk factors associated with complete tear of the anal sphincter

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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