Low rates of lateral episiotomy do not affect the incidence of advanced perineal tears.

Objective. To identify risk factors for thirdand fourth-degree perineal tears, so as to anticipate and intervene in order to prevent this complication that can severely affect a woman’s quality of life. The study design was a retrospective case control study. Method. Ninety-three cases of third- and fourth-degree perineal tears were identified from the birth register of a tertiary referral hospital (Tygerberg Hospital). One hundred and nine patients with normal vaginal deliveries in the same time period were used as control group. Results. An analysis of the results revealed that there were no significant differences between cases and controls with regards to age, body mass index (BMI), gestation at delivery, duration of second stage, episiotomy and birth weight. However, there were significantly more primigravidas, assisted deliveries (forceps and vacuum), occipitoposterior positions, HIV negative patients and shoulder dystocia in the study group. Conclusions. Antenatal risk factors for thirdand fourth-degree tears are difficult to identify. However, intrapartum occipitoposterior and assisted deliveries, especially in the primigravid patient, should warn the obstetrician/ midwife about the risk of a severe tear. A restrictive episiotomy policy should be practiced. Shoulder dystocia was invariably associated with third- and fourth-degree tears in this study. The higher incidence of HIV negative patients in the study group requires further research.

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O79 The long term outcome of third and fourth degree perineal tears

International Journal of Gynecology & Obstetrics ◽

10.1016/s0020-7292(09)60451-3 ◽

2009 ◽

Vol 107 ◽

pp. S115-S115

Author(s):

P. Bagade ◽

S. Mackenzie

Keyword(s):

Term Outcome ◽

Fourth Degree ◽

Long Term Outcome ◽

Perineal Tears

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Obstetric perineal tears in Pregnant Adolescents and the Influencing Factors

Journal of Pediatric and Adolescent Gynecology ◽

10.1016/j.jpag.2021.10.017 ◽

2021 ◽

Author(s):

Suna Yıldırım Karaca ◽

Mehmet Adıyeke ◽

Alper İleri ◽

Tayfun Vural ◽

Ayşe Rabia Şenkaya ◽

...

Keyword(s):

Influencing Factors ◽

Pregnant Adolescents ◽

Perineal Tears

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Third and fourth degree perineal tears hands-on repair course

BMJ ◽

10.1136/bmj.e774 ◽

2012 ◽

pp. e774

Author(s):

Ganesh Thiagamoorthy

Keyword(s):

Fourth Degree ◽

Perineal Tears ◽

Hands On

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Local Anaesthesia for Perineal Tears

BMJ ◽

10.1136/bmj.1.3980.836-b ◽

1937 ◽

Vol 1 (3980) ◽

pp. 836-836

Author(s):

J. R. B. McBride

Keyword(s):

Local Anaesthesia ◽

Perineal Tears

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Induction of labor and risk of third- and fourth-degree perineal tears

Journal of Obstetrics and Gynaecology Canada ◽

10.1016/j.jogc.2020.02.011 ◽

2020 ◽

Vol 42 (5) ◽

pp. 665

Author(s):

Suhaila Al-Wahaibi ◽

Nicholas Czuzoj-Shulman ◽

Haim Abenhaim

Keyword(s):

Induction Of Labor ◽

Fourth Degree ◽

Perineal Tears

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Effect of perineal massage in the second stage of labour, on the incidence of episiotomy and perineal tears

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191186 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1387

Author(s):

Abinaya Raja ◽

Pallavee P. ◽

Rupal Samal

Keyword(s):

Health Professionals ◽

Routine Care ◽

Severe Form ◽

The Other ◽

Perineal Pain ◽

Second Stage ◽

Perineal Tears ◽

Second Stage Of Labour ◽

Perineal Massage

Background: This study aimed to investigate whether perineal massage during second stage of labour could decrease perineal trauma in the form of episiotomy and perineal tears.Methods: One hundred and fifty term antenatal women in labour were randomly assigned to two groups, one of which received perineal massage and the other received routine care during the second stage. Frequency of episiotomies, perineal tears, intact perineums, degrees of perineal tears, duration of second stage of labour and perineal pain after 24 hours was compared.Results: Perineal massage was efficient in reducing incidence of episiotomy, duration of second stage of labour and perineal pain assessed 24 hours after delivery. The frequency of perineal tears and intact perineums did not differ significantly. Perineal massage was protective against severe form of third degree perineal tears.Conclusions: Authors suggest that perineal massage can be routinely practiced by health professionals to improve quality of life in women post vaginal delivery.

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Upright kneeling position during second stage of labor: a pilot study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175930 ◽

2018 ◽

Vol 7 (2) ◽

pp. 401 ◽

Cited By ~ 1

Author(s):

Anjali Dabral ◽

Pallavi Pawar ◽

Rekha Bharti ◽

Archana Kumari ◽

Achla Batra ◽

...

Keyword(s):

Tertiary Care ◽

Mode Of Delivery ◽

Admission Rate ◽

North India ◽

Care Hospital ◽

Apgar Scores ◽

Second Stage Of Labor ◽

Second Stage ◽

Perineal Tears ◽

Second Stage Of Labour

Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients’ satisfaction.Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction.Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores >7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position.Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions.

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Evaluation of Suzor forceps training by studying obstetric anal sphincter injuries: a retrospective study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03358-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Perrine COSTE MAZEAU ◽

Nedjma BOUKEFFA ◽

Nathalie TICAUD BOILEAU ◽

Samantha HUET ◽

Maud TRAVERSE ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Retrospective Study ◽

Observational Study ◽

Anal Sphincter ◽

University Hospital ◽

Obstetric Anal Sphincter Injuries ◽

Fourth Degree ◽

Perineal Tears ◽

Vacuum Extractor

Abstract Background Instrumental deliveries are an unavoidable part of obstetric practice. Dedicated training is needed for each instrument. To identify when a trainee resident can be entrusted with instrumental deliveries by Suzor forceps by studying obstetric anal sphincter injuries. Methods A French retrospective observational study of obstetric anal sphincter injuries due to Suzor forceps deliveries performed by trainee residents was conducted from November 2008 to November 2016 at Limoges University Hospital. Perineal lesion risk factors were studied. Sequential use of a vacuum extractor and then forceps was also analyzed. Results Twenty-one residents performed 1530 instrumental deliveries, which included 1164 (76.1%) using forceps and 89 (5.8%) with sequential use of a vacuum extractor and then forceps. Third and fourth degree perineal tears were diagnosed in 82 patients (6.5%). Residents caused fewer obstetric anal sphincter injuries after 23.82 (+/− 0.8) deliveries by forceps (p = 0.0041), or after 2.36 (+/− 0.7) semesters of obstetrical experience (p = 0.0007). No obese patient (body mass index> 30) presented obstetric anal sphincter injuries (p = 0.0013). There were significantly fewer obstetric anal sphincter injuries after performance of episiotomy (p < 0.0001), and more lesions in the case of the occipito-sacral position (p = 0.028). Analysis of sequential instrumentation did not find any additional associated risk. Conclusion Training in the use of Suzor forceps requires extended mentoring in order to reduce obstetric anal sphincter injuries. A stable level of competence was found after the execution of at least 24 forceps deliveries or after 3 semesters (18 months) of obstetrical experience.

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