Trends in major modifiable risk factors for severe perineal trauma, 1996-2006

Kudish, Bela; Sokol, Robert J.; Krüger, Michael

doi:10.1016/j.ijgo.2008.02.017

Cited by 60 publications

(56 citation statements)

References 28 publications

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“…1 However, maternal age was not always identified as a risk factor for severe tears. 28,37,38 Differences in risk for ethnicity have been demonstrated in studies from Norway, Sweden, UK, and the USA.…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Gurol‐Urganci

Cromwell

Edozien

et al. 2013

BJOG

346

270

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Objective To describe the trends of severe perineal tears in England and to investigate to what extent the changes in related risk factors could explain the observed trends.Design A retrospective cohort study of singleton deliveries from a national administrative database.Setting The English National Health Service between 1 April 2000 and 31 March 2012.Population A cohort of 1 035 253 primiparous women who had a singleton, term, cephalic, vaginal birth.Methods Multivariable logistic regression was used to estimate the impact of financial year of birth (labelled by starting year), adjusting for major risk factors.Main outcome measure The rate of third-degree (anal sphincter is torn) or fourth-degree (anal sphincter as well as rectal mucosa are torn) perineal tears.Results The rate of reported third-or fourth-degree perineal tears tripled from 1.8 to 5.9% during the study period. The rate of episiotomy varied between 30 and 36%. An increasing proportion of ventouse deliveries (from 67.8 to 78.6%) and non-instrumental deliveries (from 15.1 to 19.1%) were assisted by an episiotomy. A higher risk of third-or fourth-degree perineal tears was associated with a maternal age above 25 years, instrumental delivery (forceps and ventouse), especially without episiotomy, Asian ethnicity, a more affluent socio-economic status, higher birthweight, and shoulder dystocia.Conclusions Changes in major risk factors are unlikely explanations for the observed increase in the rate of third-or fourth-degree tears. The improved recognition of tears following the implementation of a standardised classification of perineal tears is the most likely explanation.Keywords Episiotomy, instrumental delivery, severe perineal trauma, trends, vaginal delivery.

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Section: Comparison With Previous Literaturementioning

confidence: 99%

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Gurol‐Urganci

Cromwell

Edozien

et al. 2013

BJOG

346

270

View full text Add to dashboard Cite

show abstract

“…Instrumental vaginal birth can increase the incidence of episiotomy, episiotomy extensions, or perineal lacerations (Cambic & Wong, 2010;Dudding et al, 2008;Mola & Kuk, 2010;Yeomans, 2010) and anal sphincter lacerations (Dudding et al, 2008;Kudish, Sokol, & Kruger, 2008). Episiotomy and/or perineal lacerations increase the mother's risk of pain, infection, and hemorrhage, and prolong recovery time (MacLeod et al, 2008).…”

Section: Episiotomy/instrumental Vaginal Birthmentioning

confidence: 99%

First Do No Harm: Interventions During Childbirth

Jansen¹,

Gibson²,

Bowles³

et al. 2013

J Perinat Educ

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Although medical and technological advances in maternity care have drastically reduced maternal and infant mortality, these interventions have become commonplace if not routine. Used appropriately, they can be life-saving procedures. Routine use, without valid indications, can transform childbirth from a normal physiologic process and family life event into a medical or surgical procedure. Every intervention presents the possibility of untoward effects and additional risks that engender the need for more interventions with their own inherent risks. Unintended consequences to intrapartum interventions make it imperative that nurse educators work with other professionals to promote natural childbirth processes and advocate for policies that focus on ensuring informed consent and alternative choices. Interdisciplinary collaboration can ensure that intrapartum caregivers "first do no harm."The Journal of Perinatal Education, 22(2),[83][84][85][86][87][88][89][90][91][92] http://dx

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“…De hecho, su práctica puede aumentar la probabilidad del desgarro por extensión de la lesión hacia esfínter y mucosa rectal 28 . Este aspecto, unido a su implicación en mayores pérdidas de Hb postparto respecto a cualquier grado de desgarro espontáneo 29 , supone un argumento más a favor de una práctica restrictiva de la episiotomía.…”

Section: Discussionunclassified