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

Poen, Alexander C.; Felt‐Bersma, R. J. F.; Dekker, Gustaaf A.; Devillé, W.L.J.M.; Cuesta, Miguel A.; Meuwissen, S. G. M.

doi:10.1111/j.1471-0528.1997.tb11533.x

Cited by 148 publications

(141 citation statements)

References 25 publications

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“…Severe laceration, such as a tear extending into the deep transverse perineal muscles and fibers of the anal sphincter (third degree) or rectal mucosa (fourth degree), is generally considered to occur with 5% of vaginal deliveries. 1 Some degree of perineal laceration, however, has been reported in up to 35% to 75% of all vaginal births. 2 A recent study found that 31% of female British obstetricians would choose cesarean delivery without any clinical indication because of concern about severe perineal damage.…”

mentioning

confidence: 99%

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

Carroll

Engelken²,

Mosier³

et al. 2003

The Journal of the American Board of Family Medicine

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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 (

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mentioning

confidence: 99%

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

Carroll

Engelken²,

Mosier³

et al. 2003

The Journal of the American Board of Family Medicine

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“…Poen et al had suggested that mediolateral episiotomy may be sphincter saving in nulliparous women. 3 Handa et al had documented likelihood of decreased 3 rd degree lacerations, but increased forth degree lacerations with episiotomy. 7 Birth weight was found to be statistically significant factor for development of obstetrical anal sphincter injuries.…”

Section: 7mentioning

confidence: 99%

“…[3][4][5] Rise in incidence is reported to be due to improved recognition of tears following implementation of standardised classification of tears.…”

Section: Introductionmentioning

confidence: 99%

“…2 Primiparous delivery, forceps delivery, macrosomic baby, Asian race are known high risk factors for obstetrical anal sphincter injuries. [3][4][5] Rise in incidence is reported to be due to improved recognition of tears following implementation of standardised classification of tears. 2 We would like to study the incidence, etiology of OASIs in Indian population.…”

Section: Introductionmentioning

confidence: 99%

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Obstetrical anal sphincter injuries and outcome of primary repair

Desai

Junnare

2016

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONOASIs (obstetrical anal sphincter injuries) involve third and fourth degree perineal tears during the process of vaginal birth. A third degree perineal tear is a partial or complete disruption of the anal sphincter muscles. A forth degree tear is a disruption of anal sphincter muscles with a breech in rectal mucosa.1 OASIs is a serious complication having bearing on quality of life of the patient in future. The data regarding OASIs in developed countries is elaborately reviewed. The incidence in developed countries is on rise.2 Primiparous delivery, forceps delivery, macrosomic baby, Asian race are known high risk factors for obstetrical anal sphincter injuries. [3][4][5] Rise in incidence is reported to be due to improved recognition of tears following implementation of standardised classification of tears.2 We would like to study the incidence, etiology of OASIs in Indian population.The objective of this study was to determine the incidence of obstetrical anal sphincter injuries (OASIs), to determine the risk factors for development of OASIs and to assess success of primary repair of OASIs. ABSTRACTBackground: OASIs (obstetrical anal sphincter injuries) involve third and fourth degree perineal tears during the process of vaginal birth. It is a grave complication as it can affect quality of life. Incidence of OASIs is on rise in developed countries. We have analyzed OASIs data from a teaching institute in India. Methods: It was a retrospective study. Data was collected from delivery register, postnatal care OPD register and case sheets of patients with OASIs. Data was analyzed to determine incidence and risk factors. The outcome of primary suturing was assessed as per records in postnatal OPD. Results: OASIs was detected in 35 patients (incidence 0.42%), third degree perineal tear was seen in 31 patients, while four patients had forth degree tear. Out of these 35 patients 21 were nullipara. Sixteen patients were instrumental deliveries, 13 and 3 delivered by outlet forceps and ventouse respectively. Primary suturing of the tear was done in 34 patients under anaesthesia. Out of 24 patients who followed up in postnatal clinic at six weeks, 14 patients were asymptomatic. Two had faecal incontinence, while eight had perineal pain. Conclusions: Nulliparity, instrumental delivery, increasing birth weight were high risk factors for obstetrical anal sphincter injuries. Obstetrician needs to be more careful while delivering a patient with multiple risk factors for OASIs. Primary suturing of anal sphincter injury with good post-operative care has a favorable outcome.

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“…In general, median episiotomy is associated with less blood loss and is easier to perform and repair than the mediolateral procedure [21]. However, median episiotomy is also associated with a higher risk of injury to the maternal anal sphincter and rectum than mediolateral episiotomies or spontaneous obstetric lacerations [22]. Mediolateral episiotomy is recommended for instrumental vaginal delivery [23].…”

Section: Episiotomymentioning

confidence: 99%

Management of the second stage of labor

2012

Intl J Gynecology & Obste

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

Cited by 148 publications

References 25 publications

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

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

Obstetrical anal sphincter injuries and outcome of primary repair

Management of the second stage of labor

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