Risk factors for perineal and vaginal tears in primiparous women – a prospective cohort study

Jansson, Markus; Fransén, Karin; Hiyoshi, Ayako; Tegerstedt, Gunilla; Dahlgren, Hedda; Nilsson, Kerstin

doi:10.21203/rs.3.rs-28633/v1

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…This is because as the gestational age increases, the estimated fetal weight increases, with increased risk of perineal injury during delivery. Studies in Sweden, [20] and Italy [21] have reported a significant association between fetal macrosomia (birth weight ≥ 4.0kg) and severe perineal tear.…”

Section: Discussionmentioning

confidence: 99%

“…Fetal macrosomia (estimated fetal weight ≥ 4.0kg) has been reported by various studies as a significant risk factor for OASI. A study in Sweden on pelvic floor in pregnancy and childbirth (POPRACT), reported a highly significant association with an odds ratio of 6.02 (2.32, 15.6) [20]. Another study in San Gerardo Hospital in Italy reported risk factors for 3 rd and 4 th degree perineal tear as birth weight > 4kg, shoulder dystocia, prolonged second stage of labour, and delivery after 40 weeks gestation [21].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Severe Perineal Tear during Delivery in Yenagoa, Southern Nigeria

Howells

Abasi

2021

AJRIMPS

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Background:Perineal tear is a very common complication of vaginal delivery, and it is often mild. However, when severe, it could result in torrential life threatening hemorrhage and anal sphincter injury, with fecal incontinence. Objective: The objective of this study is to determine the predictors of severe perineal tear (3rd and 4th degree tear), using mild perineal tear (1st and 2nd degree) as control. It would also determine the rate of perineal tear, and the maternal and fetal demographic risk factor associated with it. Materials and Methods: This was an analytic observational study of 186 women who had perineal tear during vaginal delivery. Out of these, 19 women had severe (3rd and 4th degree) perineal tear, also known as obstetrics anal sphincter injury (OASI). This was compared to 167 women who had mild perineal tear (1st and 2nd degree) during the study period. Maternal demographic information retrieved was maternal age, parity, educational level, and occupation. Obstetrics factors were booking status, gestational age at delivery, mode of delivery, rank of the accoucheur (nurse or doctor), and degree of perineal tear. Fetal demographic data was birth weight and fetal sex. Categorical variables were compared with odds ratio, difference in mean was compared with student’s t-test, and the degree of association for quantitative variables was determined using Pearson’s correlation coefficient. Predictor variables were determined using simple logistic regression, and multivariate analysis. Confidence interval was set at 95%, and statistical significance was set at p value of < 0.05. Results: The prevalence of OASI (3rd and 4th degree perineal tear) in Yenagoa was 1.1%. The significant risk factors were women of younger age, odds ratio = 1.04(0.37, 2.87) with p = 0.04, low parity, odds ratio = 0.20(0.07, 0.55) with p = 0.008, low educational background, odd ratio = 18.9(5.92, 60.81), and birth weight ≥ 4kg, odds ratio = 0.30[0.09, 1.06] with p = 0.04. Using simple liner regression, the most significant predictors for severe perineal tear were mode delivery (r2 = 65.5%), and educational level (r2 = 30.0%). However, on stepwise multivariate analysis, these two factors accounted for 68.5%. Conclusion: The rate of severe perineal tear is relatively low in Yenagoa, Nigeria, and comparable to what obtains in many countries. The most significant predictors were mode of delivery and educational level. Careful selection of the mode of delivery, especially instrumental vaginal deliveries, and women empowerment could minimize the rate in our environment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of Severe Perineal Tear during Delivery in Yenagoa, Southern Nigeria

Howells

Abasi

2021

AJRIMPS

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“…Perineal tears affect 85% of women during childbirth to varying degrees; this includes episiotomy wounds. 1 The incidence of second-degree tear, that is a tear involving the perineal muscles but not involving the anal sphincter, has been reported to be between 35.1%-78.3% in primiparous and 34.8-39.6% among multiparous patients [4] . The data on the number of patients developing wound dehiscence is lacking.…”

Section: Discussionmentioning

confidence: 99%

Management of post-partum recurrent perineal wound dehiscence with flap cover

Saple¹,

Saple²,

Gantayet³

et al. 2021

Int. J. Clin. Obstet. Gynaecol.

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Perineal wound dehiscence is a significant debilitating factor in the postpartum phase. Although the management of 3rd and 4th degree perineal tear is well described, there is no clear data about management of 2nd degree tear and wound dehiscence. Most are managed by secondary suturing or left to heal by secondary intention. Despite this many patients develop wound dehiscence and have long term complications due to scarring. In this case report we present a patient with recurrent wound dehiscence which was initially managed by multiple attempts at suturing. We did a debridement and lotus petal perforator flap to reconstruct the defect. Early use of flap cover in perineal wound dehiscence can achieve all the goals of wound management with good long term results.

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“…Perineal trauma is influenced by ethnicity, and a link has been shown between Asian ethnicity and severe perineal trauma. First pregnancy, maternal age of more than 30 years, a big infant (both in terms of weight and head size), a protracted second stage, and malposition all enhance the risk of perineal damage [9,10].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Warm Compress and Proper Perineal Support Technique on Prevention of Severe Perineal Trauma

et al. 2022

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Introduction: Vaginal deliveries are frequently linked with genital tract damage, and rips affecting the anal sphincter or mucosa (third- and fourth-degree tears) can cause major complications. To prevent harm, several perineal methods are employed to slow down the delivery of the baby’s head and allow the perineum to extend gently. Midwives all across the globe employ massage, warm compresses, and various perineal care techniques. Objective: The aim of this study was to analyze the effect of warm compress and perineal support on prevention of severe perineal trauma among primiparous women. Design: This study was a quasi-experimental study. Settings: The study settings included tertiary care hospital settings affiliated with the academic center in the UAE. Patients and Methods: Around 192 females were consecutively divided into 2 age-matched groups. Group 1 had 99 patients in which warm perineal compresses were applied in addition to perineal support, and no episiotomy was performed. There were 93 control patients in group 2 who were just given perineal support, and prophylactic episiotomy was performed. Main Outcomes Measured: Maternal risk factors such as an unhealthy perineum and short perineum were noted. The fetal risk factors such as large for gestational age, shoulder dystocia, and occipito-posterior position were also noted. Peripartum data of instrumental delivery, long stage two of delivery, oxytocin augmentation, epidural use, pushing technique, delivery position, and degree of perineal tear were also evaluated. Result: Neither maternal risk factors nor fetal factors were significant between the two groups. However, in peripartum characteristics, instrumental deliveries (17 [18.3%] vs. 0 [0%] p value <0.001) and lithotomy position (53 [57%] vs. 0 [0%] p value <0.001) were significantly more common in the control group. Other risk factors such as oxytocin augmentation, prolonged second stage, and epidural use did not differ significantly between the two groups. Warm compresses prevented severe perineal tears in group 1. Group 1 showed statistically significant (p value <0.001) reduction in severe (grade 2 and 3 tear) form of perineal injury during the second stage of labor. Conclusion: Warm perineal compresses in primigravida females during the second stage of labor may help prevent severe perineal injuries and reduce the incidence of instrumental delivery as well as lithotomy position requirement.

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Risk factors for perineal and vaginal tears in primiparous women – a prospective cohort study

Cited by 6 publications

References 19 publications

Predictors of Severe Perineal Tear during Delivery in Yenagoa, Southern Nigeria

Predictors of Severe Perineal Tear during Delivery in Yenagoa, Southern Nigeria

Management of post-partum recurrent perineal wound dehiscence with flap cover

The Effect of Warm Compress and Proper Perineal Support Technique on Prevention of Severe Perineal Trauma

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