Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2017

Open Access 01-12-2017 | Research article

Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study

Authors: Marija Simic, Sven Cnattingius, Gunnar Petersson, Anna Sandström, Olof Stephansson

Published in: BMC Pregnancy and Childbirth | Issue 1/2017

Login to get access

Abstract

Background

We sought to investigate the impact of the duration of second stage of labor on risk of severe perineal lacerations (third and fourth degree).

Methods

This population based cohort study was conducted in the Stockholm/Gotland region, Sweden, 2008–2014. Study population included 52 211 primiparous women undergoing vaginal delivery with cephalic presentation at term. Unconditional logistic regression analysis was used to calculate crude and adjusted odds ratios (OR), using 95% confidence intervals (CI). Main exposure was duration of second stage of labor, and main outcome was risks of severe perineal lacerations (third and fourth degree).

Results

Risk of severe perineal lacerations increased with duration of second stage of labor. Compared with a second stage of labor of 1 h or less, women with a second stage of more than 2 h had an increased risk (aOR 1.42; 95% CI 1.28–1.58). Compared with non-instrumental vaginal deliveries, the risk was elevated among instrumental vaginal deliveries (aOR 2.24; 95% CI 2.07–2.42). The risk of perineal laceration increased with duration of second stage of labor until less than 3 h in both instrumental and non-instrumental vaginal deliveries, but after 3 h, the ORs did not further increase. After adjustments for potential confounders, macrosomia (birth weight > 4 500 g) and occiput posterior fetal position were risk factors of severe perineal lacerations.

Conclusions

The risk of severe perineal laceration increases with duration until the third hour of second stage of labor. Instrumental delivery is the most significant risk factor for severe lacerations, followed by duration of second stage of labor, fetal size and occiput posterior fetal position.
Literature
1.
van Delft K, Sultan AH, Thakar R, Schwertner-Tiepelmann N, Kluivers K. The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction. BJOG. 2014;121(9):1164–71. discussion 72.CrossRefPubMed
2.
3.
Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol. 2003;189(6):1543–9. discussion 9–50.CrossRefPubMed
4.
5.
Altman MR, Lydon-Rochelle MT. Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: a systematic review. Birth. 2006;33(4):315–22.CrossRefPubMed
6.
Baumann P, Hammoud AO, McNeeley SG, DeRose E, Kudish B, Hendrix S. Factors associated with anal sphincter laceration in 40,923 primiparous women. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(9):985–90.CrossRefPubMed
7.
Benavides L, Wu JM, Hundley AF, Ivester TS, Visco AG. The impact of occiput posterior fetal head position on the risk of anal sphincter injury in forceps-assisted vaginal deliveries. Am J Obstet Gynecol. 2005;192(5):1702–6.CrossRefPubMed
8.
Cheng YW, Hopkins LM, Caughey AB. How long is too long: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes? Am J Obstet Gynecol. 2004;191(3):933–8.CrossRefPubMed
9.
Lowder JL, Burrows LJ, Krohn MA, Weber AM. Risk factors for primary and subsequent anal sphincter lacerations: a comparison of cohorts by parity and prior mode of delivery. Am J Obstet Gynecol. 2007;196(4):344 e1-5.CrossRefPubMed
10.
Wu JM, Williams KS, Hundley AF, Connolly A, Visco AG. Occiput posterior fetal head position increases the risk of anal sphincter injury in vacuum-assisted deliveries. Am J Obstet Gynecol. 2005;193(2):525–8. discussion 8–9.CrossRefPubMed
11.
Cheng YW, Hopkins LM, Laros Jr RK, Caughey AB. Duration of the second stage of labor in multiparous women: maternal and neonatal outcomes. Am J Obstet Gynecol. 2007;196(6):585 e1-6.CrossRefPubMed
12.
Laughon SK, Berghella V, Reddy UM, Sundaram R, Lu Z, Hoffman MK. Neonatal and maternal outcomes with prolonged second stage of labor. Obstet Gynecol. 2014;124(1):57–67.CrossRefPubMedPubMedCentral
13.
Allen VM, Baskett TF, O'Connell CM, McKeen D, Allen AC. Maternal and perinatal outcomes with increasing duration of the second stage of labor. Obstet Gynecol. 2009;113(6):1248–58.CrossRefPubMed
14.
Janni W, Schiessl B, Peschers U, Huber S, Strobl B, Hantschmann P, et al. The prognostic impact of a prolonged second stage of labor on maternal and fetal outcome. Acta Obstet Gynecol Scand. 2002;81(3):214–21.CrossRefPubMed
15.
Rouse DJ, Weiner SJ, Bloom SL, Varner MW, Spong CY, Ramin SM, et al. Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes. Am J Obstet Gynecol. 2009;201(4):357 e1-7.CrossRefPubMed
16.
Stephansson O, Sandstrom A, Petersson G, Wikstrom AK, Cnattingius S. Prolonged second stage of labour, maternal infectious disease, urinary retention and other complications in the early postpartum period. BJOG. 2016;123(4):608–16.CrossRefPubMed
17.
Murphy DJ, Macleod M, Bahl R, Goyder K, Howarth L, Strachan B. A randomised controlled trial of routine versus restrictive use of episiotomy at operative vaginal delivery: a multicentre pilot study. BJOG. 2008;115(13):1695–702. discussion 702–3.CrossRefPubMed
18.
Socialstyrelsen A. Indikation för värkstimulering med oxytocin under aktiv förlossning. Nationella medicinska indikationer. 2011.
19.
Prager M, Andersson KL, Stephansson O, Marchionni M, Marions L. The incidence of obstetric anal sphincter rupture in primiparous women: a comparison between two European delivery settings. Acta Obstet Gynecol Scand. 2008;87(2):209–15.CrossRefPubMed
20.
Faltin DL, Boulvain M, Irion O, Bretones S, Stan C, Weil A. Diagnosis of anal sphincter tears by postpartum endosonography to predict fecal incontinence. Obstet Gynecol. 2000;95(5):643–7.PubMed
21.
Cheng YW, Shaffer BL, Bianco K, Caughey AB. Timing of operative vaginal delivery and associated perinatal outcomes in nulliparous women. J Matern Fetal Neonatal Med. 2011;24(5):692–7.CrossRefPubMed
22.
Valsky DV, Lipschuetz M, Bord A, Eldar I, Messing B, Hochner-Celnikier D, et al. Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol. 2009;201(1):91 e1–7.CrossRefPubMed
23.
Loewenberg-Weisband Y, Grisaru-Granovsky S, Ioscovich A, Samueloff A, Calderon-Margalit R. Epidural analgesia and severe perineal tears: a literature review and large cohort study. J Matern Fetal Neonatal Med. 2014;27(18):1864–9.
24.
Dahl C, Kjolhede P. Obstetric anal sphincter rupture in older primiparous women: a case–control study. Acta Obstet Gynecol Scand. 2006;85(10):1252–8.CrossRefPubMed
25.
Poen AC, Felt-Bersma RJ, Dekker GA, Deville W, Cuesta MA, Meuwissen SG. Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy. Br J Obstet Gynaecol. 1997;104(5):563–6.CrossRefPubMed
26.
de Vogel J, van der Leeuw-van Beek A, Gietelink D, Vujkovic M, de Leeuw JW, van Bavel J, et al. The effect of a mediolateral episiotomy during operative vaginal delivery on the risk of developing obstetrical anal sphincter injuries. Am J Obstet Gynecol. 2012;206(5):404 e1-5.CrossRefPubMed
27.
de Leeuw JW, de Wit C, Kuijken JP, Bruinse HW. Mediolateral episiotomy reduces the risk for anal sphincter injury during operative vaginal delivery. BJOG. 2008;115(1):104–8.CrossRefPubMed
28.
Rygh AB, Skjeldestad FE, Korner H, Eggebo TM. Assessing the association of oxytocin augmentation with obstetric anal sphincter injury in nulliparous women: a population-based, case–control study. BMJ Open. 2014;4(7):e004592.CrossRefPubMedPubMedCentral
Metadata
Title
Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study
Authors
Marija Simic
Sven Cnattingius
Gunnar Petersson
Anna Sandström
Olof Stephansson
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2017
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-017-1251-6

Other articles of this Issue 1/2017

BMC Pregnancy and Childbirth 1/2017 Go to the issue

Study protocol

The use of the mHealth program Smarter Pregnancy in preconception care: rationale, study design and data collection of a randomized controlled trial

Research article

Experiences of Austrian mothers with mobility or sensory impairments during pregnancy, childbirth and the puerperium: a qualitative study

Research article

Subgroup identification of early preterm birth (ePTB): informing a future prospective enrichment clinical trial design

Research article

Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan

Study protocol

Study protocol: the Labor Progression Study, LAPS - does the use of a dynamic progression guideline in labor reduce the rate of intrapartum cesarean sections in nulliparous women? A multicenter, cluster randomized trial in Norway

Research article

Understanding factors affecting collaboration between midwives and other health care professionals in a birth center and its affiliated Quebec hospital: a case study