Perineal Trauma after Vaginal Delivery: Third and Fourth Degree Lacerations and Hematomas

2017 ◽  
pp. 99-104
Author(s):  
Anjali Martinez
Keyword(s):  
Vaginal Delivery ◽  
Perineal Trauma ◽  
Fourth Degree

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

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.

scholarly journals Characterization of pain resulting from perineal trauma in women with vaginal delivery

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Anayhan Marques Nascimento Silva ◽  
Luciano Marques dos Santos ◽  
Erika Anny Costa Cerqueira ◽  
Evanilda Souza de Santana Carvalho ◽  
Aline Silva Gomes Xavier
Keyword(s):  
Vaginal Delivery ◽  
Perineal Trauma

scholarly journals Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020578 ◽  
Author(s):  
Qi Wen ◽  
Giulia M Muraca ◽  
Joseph Ting ◽  
Sarah Coad ◽  
Kenneth I Lim ◽  
...  
Keyword(s):  
Observational Study ◽  
Vaginal Delivery ◽  
Caesarean Delivery ◽  
Temporal Trends ◽  
Birth Trauma ◽  
Forceps Delivery ◽  
Fourth Degree ◽  
Spontaneous Vaginal Delivery ◽  
Live Births ◽  
Obstetric Trauma

ObjectiveInstrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery declined. We examined concomitant temporal changes in the rates of severe birth trauma and maternal obstetric trauma.DesignA retrospective observational study.Settings and participantsAll hospital singleton live births in Washington State, USA, 2004–2013, excluding breech delivery. Severe birth trauma (brain, nerve injury, fractures and other severe birth trauma) and obstetric trauma (third/fourth degree perineal lacerations, cervical/high vaginal lacerations) were identified from hospitalisation data. Pregnancy and delivery characteristics were obtained from birth certificates. Temporal trends were assessed by the Cochran-Armitage test. Logistic regression was used to obtain adjusted ORs (AORs) and 95% CI.ResultsOverall, 732 818 live births were included. The rate of severe birth trauma declined from 5.3 in 2004 to 4.5 per 1000 live births in 2013 (P<0.001). The decline was observed only in spontaneous vaginal delivery, the rates of fractures and other severe birth trauma declined by 5% and 4% per year, respectively (AOR: 0.95, 95% CI 0.94 to 0.97 and AOR: 0.96, 95% CI 0.93 to 0.99; respectively). The rate of third/fourth degree lacerations declined in spontaneous vaginal delivery from 3.5% to 2.3% (AOR: 0.95; 95% CI 0.94 to 0.95) and in vacuum delivery from 17.3% to 14.5% (AOR: 0.97, 95% CI 0.96 to 0.98). Among women with forceps delivery, these rates declined from 29.8% to 23.4% (AOR: 0.98, 95% CI 0.96 to 1.00).ConclusionWhile the rates of fractures and other birth trauma declined among infants delivered by spontaneous vaginal delivery, the rate of birth trauma remained unchanged in instrumental vaginal delivery and caesarean delivery. Among mothers, the rates of severe perineal lacerations declined, except for women with forceps delivery.

Episiotomy, operative vaginal delivery, and significant perineal trauma in nulliparous women

1999 ◽  
Vol 181 (5) ◽  
pp. 1180-1184 ◽  
Author(s):  
Julian N. Robinson ◽  
Errol R. Norwitz ◽  
Amy P. Cohen ◽  
Thomas F. McElrath ◽  
Ellice S. Lieberman
Keyword(s):  
Vaginal Delivery ◽  
Perineal Trauma ◽  
Operative Vaginal Delivery ◽  
Nulliparous Women

Simulation Training for Forceps-Assisted Vaginal Delivery and Rates of Maternal Perineal Trauma

2016 ◽  
Vol 128 (3) ◽  
pp. 429-435 ◽  
Author(s):  
Dana R. Gossett ◽  
Douglas Gilchrist-Scott ◽  
Diane B. Wayne ◽  
Susan E. Gerber
Keyword(s):  
Vaginal Delivery ◽  
Simulation Training ◽  
Perineal Trauma ◽  
Assisted Vaginal Delivery

scholarly journals Obstetric perineal tears, sexual function and dyspareunia among primiparous women 12 months postpartum: a prospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032368 ◽  
Author(s):  
Ditte Gommesen ◽  
Ellen Nøhr ◽  
Niels Qvist ◽  
Vibeke Rasch
Keyword(s):  
Cohort Study ◽  
Sexual Health ◽  
Sexual Function ◽  
Vaginal Delivery ◽  
Prospective Cohort Study ◽  
Clinical Examination ◽  
Prospective Cohort ◽  
Fourth Degree ◽  
Primiparous Women ◽  
Second Degree

ObjectiveSexuality is an important aspect of human identity and contributes significantly to the quality of life in women as well as in men. Impairment in sexual health after vaginal delivery is a major concern for many women. We aimed to examine the association between degree of perineal tear and sexual function 12 months postpartum.DesignA prospective cohort studySettingFour Danish hospitals between July 2015 and January 2019ParticipantsA total of 554 primiparous women: 191 with no/labia/first-degree tears, 189 with second-degree tears and 174 with third-degree/fourth-degree tears. Baseline data were obtained 2 weeks postpartum by a questionnaire and a clinical examination. Sexual function was evaluated 12 months postpartum by an electronic questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12)) and a clinical examination.Primary outcome measuresTotal PISQ-12 score and dyspareuniaResultsEpisiotomy was performed in 54 cases and 95 women had an operative vaginal delivery. The proportion of women with dyspareunia was 25%, 38% and 53% of women with no/labia/first-degree, second-degree or third-degree/fourth-degree tears, respectively.Compared with women with no/labia/first-degree tears, women with second-degree or third-degree/fourth-degree tears had a higher risk of dyspareunia (adjusted relative risk (aRR) 2.05; 95% CI 1.51 to 2.78 and aRR 2.09; 95% CI 1.55 to 2.81, respectively). Women with third-degree/fourth-degree tears had a higher mean PISQ-12 score (12.2) than women with no/labia/first-degree tears (10.4).ConclusionsImpairment of sexual health is common among primiparous women after vaginal delivery. At 12 months postpartum, more than half of the women with a third-degree/fourth-degree tear experienced dyspareunia. Women delivering with no/labia/first-degree tears reported the best outcomes overall. Thus, it is important to minimise the extent of perineal trauma and to counsel about sexuality during and after pregnancy.

Prolonged Second Stage of Labor and Anal Sphincter Injury in a Contemporary Cohort of Term Nulliparas

2020 ◽  
Author(s):  
Mariam Naqvi ◽  
Elana F. Jaffe ◽  
Ilona T. Goldfarb ◽  
Allison S. Bryant ◽  
Blair J. Wylie ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Sphincter Injury ◽  
Predictive Capacity ◽  
Fourth Degree ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Anal Sphincter Injury ◽  
Operative Vaginal Delivery ◽  
Multivariable Regression

Objective This study aimed to assess whether a prolonged second stage of labor is an independent predictor of obstetric anal sphincter injury (OASI) in a contemporary cohort of nulliparous and term parturients, and to evaluate whether predelivery factors can accurately predict OASI. Study Design This was a nested case-control study within a cohort of consecutive nulliparous term parturients with a singleton gestation who underwent a vaginal delivery at a single institution between January 2014 and January 2015. Cases were defined as women with a third- or fourth-degree laceration at the time of delivery, and controls were women without a third- or fourth-degree laceration. A prolonged second stage was defined as a second stage of ≥3 hours. Univariable and multivariable regression analyses were performed to examine the relationship between prolonged second stage of labor and third- or fourth-degree lacerations. Receiver operator curves were developed to assess the predictive capacity of predelivery information for third- and fourth-degree lacerations. Results Of 1,197 births, 63 women had third- or fourth-degree lacerations (5.3%). With each additional hour of the second stage, the rate of OASI increased, with 2.9% of women with a second stage of <1 hour with OASI, 3.5% between 1 and 2 hours, 5.7% between 2 and 3 hours, 7.8% between 3 and 4 hours, 16.1% between 4 and 5 hours, and 28.6% among women with a second stage length >5 hours (p < 0.001). In multivariable regression analysis, operative vaginal delivery (adjusted odds ratio [aOR] = 5.92, 95% confidence interval [CI]: 3.17–11.07) and a prolonged second stage (aOR = 1.92, 95% CI: 1.06–3.51) were independent predictors of third- and fourth-degree lacerations. A predictive model was developed from these results (area under the curve [AUC] = 0.75, 95% CI: 0.68–0.81). Conclusion Prolonged second stage of labor is a predictor of OASI, after adjustment for operative vaginal delivery. A model using predelivery risk factors has a reasonable prediction of OASI. Key Points

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