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Risk factors for severe obstetric perineal lacerations

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Abstract

Introduction and hypothesis

The aim of this study was to assess the occurrence of severe perineal lacerations in vaginal delivery and its relationship with predisposing clinical and obstetric factors.

Methods

A retrospective cohort analysis using an electronic clinical database at a University Referral Center for high-risk pregnancies was performed. A total of 941 vaginal deliveries were analyzed, over 10 consecutive months in 2013 and 2014. The relationship between obstetric and clinical characteristics and lacerations, especially severe forms, was analyzed. The frequency and severity of birth canal lacerations were compiled and classified as mild (unintentional laceration grades I and II, and mediolateral episiotomy) and severe (grades III and IV). The crude and adjusted odds ratios and 95 % confidence intervals were estimated in univariate and multivariate logistic regression models.

Results

The overall incidence of perineal lacerations in vaginal delivery was 78.2 % (n = 731). Lacerations were considered mild in 708 women (75.7 %) and severe in 23 women (2.5 %). Maternal age, parity, use of forceps, mediolateral episiotomy, and birth weight influenced the occurrence of some degree of tear. The chance of severe lacerations increased 1.77-fold per week with the gestational age (1.03–3.03, P = 0.025), while primiparity increased the chance of laceration 5.32-fold. Episiotomy did not show a protective effect against severe laceration occurrence (P = 0.999).

Conclusions

Severe perineal lacerations were associated with operative delivery, primiparity, gestational age, and epidural anesthesia. Episiotomy was not protective.

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Acknowledgments

The authors thank Fundação de Amparo a Pesquisa de Minas Gerais – FAPEMIG/Brazil and Pro-Reitoria de Pesquisa da Universidade Federal de Minas Gerais/Brazil.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190 – 2. andar, Belo Horizonte, 30130-100, Brazil

    Marilene Vale de Castro Monteiro, Regina Amélia Pessoa Aguiar, Mário Dias Correia-Junior & Zilma Silveira Nogueira Reis

  2. Center of Medical Informatics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    Zilma Silveira Nogueira Reis

  3. Urogynaecology, City Council Para de Minas, Minas Gerais, Brazil

    Gláucia M. Varella Pereira

  4. School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    Rodrigo Leite Azevedo

  5. Otto Cirne Maternity, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    Mário Dias Correia-Junior

Authors
  1. Marilene Vale de Castro Monteiro
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  2. Gláucia M. Varella Pereira
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  3. Regina Amélia Pessoa Aguiar
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  6. Zilma Silveira Nogueira Reis
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Corresponding author

Correspondence to Marilene Vale de Castro Monteiro.

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Vale de Castro Monteiro, M., Pereira, G.M.V., Aguiar, R.A.P. et al. Risk factors for severe obstetric perineal lacerations. Int Urogynecol J 27, 61–67 (2016). https://doi.org/10.1007/s00192-015-2795-5

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  • DOI: https://doi.org/10.1007/s00192-015-2795-5

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