scholarly journals Risk factors for perineal and vaginal tears in primiparous women – a prospective cohort study

2020 ◽  
Author(s):  
Markus Harry Jansson ◽  
Karin Franzén ◽  
Ayako Hiyoshi ◽  
Gunilla Tegerstedt ◽  
Hedda Dahlgren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Vacuum Extraction ◽  
Perineal Tears ◽  
Independent Risk Factors ◽  
Primiparous Women ◽  
Second Degree

Abstract BackgroundThe aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries, and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears.MethodsAll nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models.ResultsA total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (adjusted odds ratio 2.26 (95% CI: 1.22, 4.19) and 3.28 (95% CI: 1.73, 6.21) respectively) and OASI (adjusted odds ratio 5.93 (95% CI: 2.29, 15.33) and 4.31 (95% CI: 1.49, 12.5) respectively), whereas age above 25 years only increased the risk of second-degree perineal tears (adjusted odds ratio 1.94 (95% CI: 1.10, 3.43)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (adjusted odds ratio 2.33 (95% CI: 1.09, 5.00), 3.64 (95% CI: 1.54, 8.59) and 2.86 (95% CI: 1.43, 5.75) respectively).ConclusionsThis prospective study showed that fetal weight exceeding 4000 g and vacuum extraction are independent risk factors for both second-degree perineal tears and OASI in primiparous women. Risk factors for high vaginal tears were heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, and fetal head circumference > 35 cm. These tears have been found to be common among primiparous women, and merit more attention.Brief summary: This prospective cohort study showed that fetal birthweight exceeding 4000 g and vacuum extraction increased the risk of second-degree tear and anal sphincter injury.

scholarly journals Risk factors for perineal and vaginal tears in primiparous women – the prospective POPRACT-cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Markus Harry Jansson ◽  
Karin Franzén ◽  
Ayako Hiyoshi ◽  
Gunilla Tegerstedt ◽  
Hedda Dahlgren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Pelvic Floor Dysfunction ◽  
Vacuum Extraction ◽  
Fetal Head ◽  
Perineal Tear ◽  
Perineal Tears ◽  
Independent Risk Factors ◽  
Primiparous Women ◽  
Second Degree

Abstract Background The aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries (OASI), and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears. Methods All nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models. Results A total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (aOR 2.22 (95% CI: 1.17, 4.22) and 2.41 (95% CI: 1.24, 4.68) respectively) and OASI (aOR 6.02 (95% CI: 2.32, 15.6) and 3.91 (95% CI: 1.32, 11.6) respectively). Post-term delivery significantly increased the risk for second-degree perineal tear (aOR 2.44 (95% CI: 1.03, 5.77), whereas, maternal birth positions with reduced sacrum flexibility significantly decreased the risk of second-degree perineal tear (aOR 0.53 (95% CI 0.32, 0.90)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, vacuum extraction and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (aOR 2.32 (95% CI 1.09, 4.97), 3.16 (95% CI 1.31, 7.62), 2.53 (95% CI: 1.07, 5.98) and 3.07 (95% CI 1.5, 6.3) respectively). Conclusion The present study corroborates previous findings of vacuum extraction and fetal weight exceeding 4000 g as risk factors of OASI. We found that vacuum extraction is a risk factor for second-degree tear, and vacuum extraction, fetal head circumference exceeding 35 cm and heredity of pelvic floor dysfunction and/or connective tissue deficiency were associated with increased risk of high vaginal tears. These findings have not been documented previously and should be confirmed by additional studies.

scholarly journals Risk factors for perineal and vaginal tears in primiparous women – the prospective POPRACT-cohort study

2020 ◽  
Author(s):  
Markus Harry Jansson ◽  
Karin Franzén ◽  
Ayako Hiyoshi ◽  
Gunilla Tegerstedt ◽  
Hedda Dahlgren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Pelvic Floor Dysfunction ◽  
Vacuum Extraction ◽  
Fetal Head ◽  
Perineal Tear ◽  
Perineal Tears ◽  
Independent Risk Factors ◽  
Primiparous Women ◽  
Second Degree

Abstract BackgroundThe aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries (OASI), and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears.MethodsAll nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models.ResultsA total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (aOR 2.22 (95% CI: 1.17, 4.22) and 2.41 (95% CI: 1.24, 4.68) respectively) and OASI (aOR 6.02 (95% CI: 2.32, 15.6) and 3.91 (95% CI: 1.32, 11.6) respectively). Post-term delivery significantly increased the risk for second-degree perineal tear (aOR 2.44 (95% CI: 1.03, 5.77), whereas, maternal birth positions with reduced sacrum flexibility significantly decreased the risk of second-degree perineal tear (aOR 0.53 (95% CI 0.32, 0.90)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, vacuum extraction and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (aOR 2.32 (95% CI 1.09, 4.97), 3.16 (95% CI 1.31, 7.62), 2.53 (95% CI: 1.07, 5.98) and 3.07 (95% CI 1.5, 6.3) respectively).ConclusionThe present study corroborates previous findings of vacuum extraction and fetal weight exceeding 4000 g as risk factors of OASI. We found that vacuum extraction is a risk factor for second-degree tear, and vacuum extraction, fetal head circumference exceeding 35 cm and heredity of pelvic floor dysfunction and/or connective tissue deficiency were associated with increased risk of high vaginal tears. These findings have not been documented previously and should be confirmed by additional studies.

scholarly journals Risk factors for perineal and vaginal tears in primiparous women – the prospective POPRACT-cohort study

2020 ◽  
Author(s):  
Markus Harry Jansson ◽  
Karin Franzén ◽  
Ayako Hiyoshi ◽  
Gunilla Tegerstedt ◽  
Hedda Dahlgren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Pelvic Floor Dysfunction ◽  
Vacuum Extraction ◽  
Fetal Head ◽  
Perineal Tear ◽  
Perineal Tears ◽  
Independent Risk Factors ◽  
Primiparous Women ◽  
Second Degree

Abstract Background The aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries (OASI), and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears.Methods All nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models.Results A total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (aOR 2.22 (95% CI: 1.17, 4.22) and 2.41 (95% CI: 1.24, 4.68) respectively) and OASI (aOR 6.02 (95% CI: 2.32, 15.6) and 3.91 (95% CI: 1.32, 11.6) respectively). Post-term delivery significantly increased the risk for second-degree perineal tear (aOR 2.44 (95% CI: 1.03, 5.77), whereas, maternal birth positions with reduced sacrum flexibility significantly decreased the risk of second-degree perineal tear (aOR 0.53 (95% CI 0.32, 0.90)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, vacuum extraction and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (aOR 2.32 (95% CI 1.09, 4.97), 3.16 (95% CI 1.31, 7.62), 2.53 (95% CI: 1.07, 5.98) and 3.07 (95% CI 1.5, 6.3) respectively).Conclusion The present study corroborates previous findings of vacuum extraction and fetal weight exceeding 4000 g as risk factors of OASI. We found that vacuum extraction is a risk factor for second-degree tear, and vacuum extraction, fetal head circumference exceeding 35 cm and heredity of pelvic floor dysfunction and/or connective tissue deficiency were associated with increased risk of high vaginal tears. These findings have not been documented previously and should be confirmed by additional studies.

scholarly journals Prevalence and Antimicrobial Resistance of Mycoplasma genitalium Infection Among Women Living With Human Immunodeficiency Virus in South Africa: A Prospective Cohort Study

2019 ◽  
Vol 69 (5) ◽  
pp. 873-876 ◽  
Author(s):  
Jason J Ong ◽  
Mahlape Precious Magooa ◽  
Admire Chikandiwa ◽  
Helen Kelly ◽  
Marie-Noelle Didelot ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Mycoplasma Genitalium ◽  
Cd4 Counts ◽  
Immunodeficiency Virus ◽  
Hiv 1

Abstract This prospective cohort study of 622 women living with human immunodeficiency virus (HIV) from Johannesburg (2012) detected Mycoplasma genitalium in 7.4% (95% confidence interval [CI]: 5.5–9.7, 46/622), with detection more likely with lower CD4 counts(adjusted odds ratio [AOR] 1.02 per 10 cells/μL decrease, 95% CI: 1.00–1.03) and higher plasma HIV-1 RNA (AOR 1.15 per log copies/mL increase, 95% CI: 1.03–1.27). No mutations for macrolide/quinolone resistance was detected.

scholarly journals Risk Factors for Umbilical Cord Prolapse at the Time of Artificial Rupture of Membranes

2018 ◽  
Vol 08 (02) ◽  
pp. e89-e94 ◽  
Author(s):  
Tetsuya Kawakita ◽  
Chun-Chih Huang ◽  
Helain Landy
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Adjusted Odds Ratio ◽  
Cervical Dilation ◽  
Cord Prolapse ◽  
Umbilical Cord Prolapse ◽  
Singleton Pregnancies

Objective The aim of the study was to examine the association between cervical exam at the time of artificial rupture of membranes (AROM) and cord prolapse. Study Design We conducted a retrospective cohort study using the data from the Consortium on Safe Labor. We included women with cephalic presentation and singleton pregnancies at ≥ 23 weeks' gestation who underwent AROM during the course of labor. Multivariable logistic regression was used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (95% CI), controlling for prespecified covariates. Results Of 57,204 women who underwent AROM, cord prolapse occurred in 113 (0.2%). Compared with dilation 6 to 10 cm + station ≥ 0 at the time of AROM, <6 cm + any station and 6–10 cm + station ≤ −3 were associated with increased risks of cord prolapse (<6 cm + station ≤ −3 [aOR, 2.29; 95% CI, 1.02–5.40]; <6 cm + station −2.5 to −0.5 [aOR, 2.34; 95% CI, 1.23–4.97]; <6 cm + station ≥ 0 [aOR, 3.31; 95% CI, 1.39–8.09]; and 6–10 cm + station ≤ −3 [aOR, 5.47; 95% CI, 1.35–17.48]). Conclusion Cervical dilation < 6 cm with any station and 6 to 10 cm with station ≤ −3 were associated with a higher risk of cord prolapse.

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.

scholarly journals Risk factors associated with pain in patients with venous malformations of the extremities

2018 ◽  
Vol 24 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Li Hu ◽  
Hui Chen ◽  
Xi Yang ◽  
Yongying Wang ◽  
Hao Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Univariate Analysis ◽  
Lesion Size ◽  
Common Symptom ◽  
Type Ii ◽  
Venous Malformations ◽  
Average Pain ◽  
Independent Risk Factors

Pain is a common symptom and the major complaint in patients with venous malformations of the extremities, which may lead to joint dysfunction and even walking disabilities. Therefore, this study aimed to investigate determined independent risk factors for pain in these patients. We retrospectively collected data for 168 patients with venous malformations of the extremities from January 16, 2013 to August 13, 2015. They were categorized into painful and painless groups according to the symptom and pain scores. Associations between pain and candidate factors were determined using univariate and multivariate analyses. A total of 125 (74.4%) patients with an average pain score of 4.4 were included in the painful group. In univariate analysis, age, lesion size, tissue involvement, and phleboliths were associated with pain. In the multivariate analysis, only type-II tissue involvement (adjusted odds ratio 4.57; p = 0.001) and phleboliths (adjusted odds ratio 2.44; p = 0.039) were identified as the independent risk factors. In conclusion, this study revealed that prevalence of pain in patients with venous malformations of the extremities was high. Patients who presented with type-II tissue involvement and phleboliths are more likely to suffer from pain.

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