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05-03-2024 | Perineal Laceration

First and Second Stage Risk Factors Associated with Perineal Lacerations

Authors: Alexander M. Saucedo, Methodius G. Tuuli, W. Thomas Gregory, Holly E. Richter, Jerry L. Lowder, Candice Woolfolk, Aaron B. Caughey, Sindhu K. Srinivas, Alan T. N. Tita, George A. Macones, Alison G. Cahill

Published in: Maternal and Child Health Journal

Abstract

Objective

To determine intrapartum factors associated with perineal laceration at delivery.

Methods

This was a planned secondary analysis of a multicenter randomized clinical trial of delayed versus immediate pushing among term nulliparous women in labor with neuraxial analgesia conducted in the United States. Intrapartum characteristics were extracted from the medical charts. The primary outcome was perineal laceration, defined as second degree or above, characterized at delivery in women participating in longer term pelvic floor assessments post-delivery. Multivariable logistic regression was used to refine risk estimates while adjusting for randomization group, birth weight, and maternal age.

Results

Among the 941 women participating in the pelvic floor follow-up, 40.6% experienced a perineal laceration. No first stage labor characteristics were associated with perineal laceration, including type of labor or length of first stage. Receiving an amnioinfusion appeared protective of perineal laceration (adjusted odds ratio, 0.48; 95% confidence interval 0.26–0.91; P = 0.01). Second stage labor characteristics associated with injury were length of stage (2.01 h vs. 1.50 h; adjusted odds ratio, 1.36; 95% confidence interval 1.18–1.57; P < 0.01) and a prolonged second stage (adjusted odds ratio, 1.64; 95% confidence interval 1.06–2.56; P < 0.01). Operative vaginal delivery was strongly associated with perineal laceration (adjusted odds ratio, 3.57; 95% confidence interval 1.85–6.90; P < 0.01).

Conclusion

Operative vaginal delivery is a modifiable risk factor associated with an increased risk of perineal laceration. Amnioinfusion appeared protective against injury, which could reflect a spurious finding, but may also represent true risk reduction similar to the mechanism of warm perineal compress.

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Title: First and Second Stage Risk Factors Associated with Perineal Lacerations
Authors: Alexander M. Saucedo
Methodius G. Tuuli
W. Thomas Gregory
Holly E. Richter
Jerry L. Lowder
Candice Woolfolk
Aaron B. Caughey
Sindhu K. Srinivas
Alan T. N. Tita
George A. Macones
Alison G. Cahill
Publication date: 05-03-2024
Publisher: Springer US
Keyword: Perineal Laceration
Published in: Maternal and Child Health Journal
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-024-03919-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

First and Second Stage Risk Factors Associated with Perineal Lacerations

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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