nach oben

Erschienen in:

01.01.2010 | Original Article

Advanced age is a risk factor for higher grade perineal lacerations during delivery in nulliparous women

verfasst von: Amadeus Hornemann, Axel Kamischke, Doerte W. Luedders, Daniel A. Beyer, Klaus Diedrich, Michael K. Bohlmann

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 1/2010

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To identify risk factors for the development of severe perineal lacerations and to give recommendations for their prevention in nulliparous women.

Methods

A retrospective case–control analysis of deliveries at our University Hospital was performed. Multiparae, Caesarean sections, twin pregnancies, fetal breech position and preterm deliveries were excluded. Univariate and multivariate step forward regression analyses were performed; correlations between contributors were further analyzed by Spearman Rank Correlation. Differences between the degree of lacerations and maternal age were further analyzed with Friedman ANOVA followed by Dunn’s Multiple Comparison Test.

Results

A total of 2,967 deliveries fitted our inclusion criteria, 50 (1.7%) mothers had higher-grade lacerations. Mediolateral and median episiotomy, advanced maternal age, vaginal operative delivery, higher fetal birth weight and abnormal cephalic presentation were associated with severe lacerations.

Conclusions

Advanced maternal age plays an important role in the development of anal sphincter tears in nulliparous women. Episiotomy and operative vaginal deliveries should be restrictively performed when possible. To identify further preventive approaches in patients with accumulated risk factors prospective randomized studies are needed.

Poen AC, Felt-Bersma RJ, Dekker GA, Devillé W, Cuesta MA, Meuwissen SG (1997) Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy. Br J Obstet Gynaecol 104:563–566PubMed

Burrows LJ, Meyn LA, Weber AM (2004) Maternal morbidity associated with vaginal versus cesarean delivery. Obstet Gynecol 103:907–912PubMed

Caughey AB, Stotland NE, Washington AE, Escobar GJ (2007) Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term. Am J Obstet Gynecol 196:155.e1–155.e6CrossRef

Brubaker L, Handa VL, Bradley CS, Connolly A, Moalli P, Brown MB, Weber A, Pelvic Floor Disorders Network (2008) Sexual function 6 months after first delivery. Obstet Gynecol 111:1040–1044PubMed

Baumann P, Hammoud AO, McNeeley SG, DeRose E, Kudish B, Hendrix S (2007) Factors associated with anal sphincter laceration in 40, 923 primiparous women. Int Urogynecol J Pelvic Floor Dysfunct 18:985–990. doi:10.1007/s00192-006-0274-8 CrossRefPubMed

Altman D, Ragnar I, Ekström A, Tydén T, Olsson SE (2007) Anal sphincter lacerations and upright delivery postures—a risk analysis from a randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct 18:141–146. doi:10.1007/s00192-006-0123-9 PubMed

Lunenfeld B (2008) An aging world-demographics and challenges. Gynecol Endocrinol 24:1–3. doi:10.1080/09513590701718364 CrossRefPubMed

National Institutes of Health state-of-the-science conference statement (2006) Cesarean delivery on maternal request. Obstet Gynecol 107:1386–1397

Ecker JL, Frigoletto FD Jr (2007) Cesarean delivery and the risk-benefit calculus. N Engl J Med 356:885–888. doi:10.1056/NEJMp068290 CrossRefPubMed

10.

Surkan PJ, Hsieh C-C, Johansson ALV, Dickman PW, Cnattingius S (2004) Reasons for increasing trends in large for gestational age births. Obstet Gynecol 104:720–726PubMed

11.

Ben-Haroush A, Hadar E, Chen R, Hod M, Yogev Y (2009) Maternal obesity is a major risk factor for large-for-gestational-infants in pregnancies complicated by gestational diabetes. Arch Gynecol Obstet 279:539–543. doi:10.1007/s00404-008-0767-4 CrossRefPubMed

12.

Kramer MS, Morin I, Yang H, Platt RW, Usher R, McNamara H, Joseph KS, Wen SW (2002) Why are babies getting bigger? Temporal trends in fetal growth and its determinants. J Pediatr 141:538–542. doi:10.1067/mpd.2002.128029 CrossRefPubMed

13.

Odlind V, Haglund B, Pakkanen M, Otterblad Olausson P (2003) Deliveries, mothers and newborn infants in Sweden, 1973–2000. Trends in obstetrics as reported to the Swedish medical birth register. Acta Obstet Gynecol Scand 82:516–528. doi:10.1034/j.1600-0412.2003.00112.x CrossRefPubMed

14.

Lewis C, Williams AM, Rogers RG (2008) Postpartum anal sphincter lacerations in a population with minimal exposure to episiotomy and operative vaginal delivery. Int Urogynecol J Pelvic Floor Dysfunct 19:41–45. doi:10.1007/s00192-007-0402-0 PubMed

15.

Nakai A, Yoshida A, Yamaguchi S, Kawabata I, Hayashi M, Yokota A, Isozaki T, Takeshita T (2006) Incidence and risk factors for severe perineal laceration after vaginal delivery in Japanese patients. Arch Gynecol Obstet 274:222–226. doi:10.1007/s00404-006-0168-5 CrossRefPubMed

16.

Sheiner E, Levy A, Walfisch A, Hallak M, Mazor M (2005) Third degree perineal tears in a university medical center where midline episiotomies are not performed. Arch Gynecol Obstet 271:307–310. doi:10.1007/s00404-004-0610-5 CrossRefPubMed

17.

Ziadeh SM (2002) Maternal and perinatal outcome in nulliparous women aged 35 and older. Gynecol Obstet Invest 54:6–10. doi:10.1159/000064689 CrossRefPubMed

18.

Voigt M, Rochow N, Zygmunt M, Straube S, Schneider KT, Briese V (2008) Risks of pregnancy and birth, birth presentation, and mode of delivery in relation to the age of primiparous women. Z Geburtshilfe Neonatol 212:206–210. doi:10.1055/s-0028-1098732 CrossRefPubMed

19.

Uyar Y, Erbay G, Demir BC, Baytur Y (2009) Comparison of the Bishop score, body mass index and transvaginal cervical length in predicting the success of labor induction. Arch Gynecol Obstet [Epub ahead of print]

20.

Gülmezoglu AM, Crowther CA, Middleton P (2006) Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 4:CD004945

Titel: Advanced age is a risk factor for higher grade perineal lacerations during delivery in nulliparous women
verfasst von: Amadeus Hornemann
Axel Kamischke
Doerte W. Luedders
Daniel A. Beyer
Klaus Diedrich
Michael K. Bohlmann
Publikationsdatum: 01.01.2010
Verlag: Springer-Verlag
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 1/2010
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-009-1063-7

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Advanced age is a risk factor for higher grade perineal lacerations during delivery in nulliparous women