Risk factors for third-degree and fourth-degree perineal lacerations in forceps and vacuum deliveries

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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Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda

Obstetrics and Gynecology International ◽

10.1155/2020/6035974 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Mahad Ali ◽

Richard Migisha ◽

Joseph Ngonzi ◽

Joy Muhumuza ◽

Ronald Mayanja ◽

...

Keyword(s):

Risk Factors ◽

Vaginal Delivery ◽

Anal Sphincter ◽

Tertiary Hospital ◽

Monthly Income ◽

Obstetric Anal Sphincter Injuries ◽

Perineal Tear ◽

Fourth Degree ◽

Anal Sphincter Injury ◽

Second Stage Of Labour

Background. Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS. Objectives. To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH). Methods. We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants’ medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors. Results. The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2nd stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86–19.82, p=0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07–6.17, p=0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01–0.12, p<0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03–0.28, p<0.001). Conclusions and Recommendations. The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.

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Prevalence of Episiotomy and Perineal Lacerations in a University Teaching Hospital, North-Central Nigeria

Journal of BioMedical Research and Clinical Practice ◽

10.46912/jbrcp.49 ◽

2018 ◽

Vol 1 (2) ◽

pp. 142-147

Author(s):

S K Hembah-Hilekaan ◽

A O Ojabo ◽

O Audu ◽

P E Onche ◽

M T Maanongun

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Teaching Hospital ◽

Maternal Age ◽

Fetal Weight ◽

University Teaching ◽

Warning Sign ◽

Perineal Laceration ◽

Perineal Lacerations ◽

Vaginal Deliveries

Episiotomy is an incision on the introitus and the perineum to increase pelvic outlet to facilitate childbirth and prevent trauma to fetal and maternal tissues. Episiotomy and perineal laceration may predispose the woman to short and long term complications. The objective of this study was to determine the prevalence of episiotomy and perineal lacerations and their associated risks factors at Benue State University Teaching Hospital, Makurdi, Nigeria. Retrospective data of all women who had spontaneous vagina delivery over a 3 year period with perineal laceration/episiotomy were reviewed. Data was obtained from the records and information on the socio-demographic variables, episiotomies, lacerations and the birth weight of infants. The associated risk factors were recorded using Statistical Package for Social Sciences version 22.Of the 636 vaginal deliveries, 85(13.4%) had lacerations with 65(10.2%) first degree, 19(3.0%) second degree and 1(0.2%) major laceration. Episiotomy rate was 132(20.8%). The mean parity and birth weight of infants were 2.62(SD= ± 1.83) and 3.1 kg (SD= ± 0.767) respectively. The highest number of perineal tears 69(10.8%) were in the lower age group (≤ 30 years). A similar observation was noted in respect of episiotomies which rate however decreased with parity. The relationship between maternal age, parity, booking status, fetal weight and the perineal status at delivery was statistically significant (P≤ 0.05). Episiotomy and perineal laceration rates in our institution were low. The major risk factors were low parity, young maternal age and increasing fetal weight at birth and their presence should be an early warning sign. We advise perineal support for all women during delivery.

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Risk factors for severe obstetric perineal lacerations

International Urogynecology Journal ◽

10.1007/s00192-015-2795-5 ◽

2015 ◽

Vol 27 (1) ◽

pp. 61-67 ◽

Cited By ~ 27

Author(s):

Marilene Vale de Castro Monteiro ◽

Gláucia M. Varella Pereira ◽

Regina Amélia Pessoa Aguiar ◽

Rodrigo Leite Azevedo ◽

Mário Dias Correia-Junior ◽

...

Keyword(s):

Risk Factors ◽

Perineal Lacerations

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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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