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International Urogynecology Journal

Published in:

01-02-2007 | Original Article

Anal sphincter lacerations and upright delivery postures—a risk analysis from a randomized controlled trial

Authors: Daniel Altman, Inga Ragnar, Åsa Ekström, Tanja Tydén, Sven-Eric Olsson

Published in: International Urogynecology Journal | Issue 2/2007

Abstract

Objective

To evaluate obstetric sphincter lacerations after a kneeling or sitting position at second stage of labor in a multivariate risk analysis model.

Materials and methods

Two hundred and seventy-one primiparous women with normal pregnancies and spontaneous labor were randomized, 138 to a kneeling position and 133 to a sitting position. Medical data were retrieved from delivery charts and partograms. Risk factors were tested in a multivariate logistic regression model in a stepwise manner.

Results

The trial was completed by 106 subjects in the kneeling group and 112 subjects in the sitting group. There were no significant differences with regard to duration of second stage of labor or pre-trial maternal characteristics between the two groups. Obstetrical sphincter tears did not differ significantly between the two groups but an intact perineum was more common in the kneeling group (p<0.03) and episiotomy (mediolateral) was more common in the sitting group (p<0.05). Three grade IV sphincter lacerations occurred in the sitting group compared to none in the kneeling group (NS). Multivariate risk analysis indicated that prolonged duration of second stage of labor and episiotomy were associated with an increased risk of third- or fourth-degree sphincter tears (p<0.01 and p<0.05, respectively). Delivery posture, maternal age, fetal weight, use of oxytocin, and use of epidural analgesia did not increase the risk of obstetrical anal sphincter lacerations in the two upright postures.

Conclusion

Obstetrical anal sphincter lacerations did not differ significantly between a kneeling or sitting upright delivery posture. Episiotomy was more common after a sitting delivery posture, which may be associated with an increased risk of anal sphincter lacerations. Upright delivery postures may be encouraged in healthy women with normal, full-term pregnancy.

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Title: Anal sphincter lacerations and upright delivery postures—a risk analysis from a randomized controlled trial
Authors: Daniel Altman
Inga Ragnar
Åsa Ekström
Tanja Tydén
Sven-Eric Olsson
Publication date: 01-02-2007
Publisher: Springer-Verlag
Published in: International Urogynecology Journal / Issue 2/2007
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-006-0123-9

At a glance: The STEP trials

Springer Medicine

Anal sphincter lacerations and upright delivery postures—a risk analysis from a randomized controlled trial

Abstract

Objective

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusion

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