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Created on : 12 Jun 2004
Modified on : 05 Nov 2018

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Bibliographical entry (without author) :

Third and fourth degree perineal tears. Predictor factors in a referral hospital. Acta Obstet Gynecol Scand. 2001 Mar;80(3):229-34.

Author(s) :

Jander C, Lyrenas S.

Year of publication :


URL(s) :

Résumé (français)  :

Abstract (English)  :

BACKGROUND: Tears of the anal sphincter are a feared complication of vaginal delivery, as many as 50% of these patients experience incontinence as an after-effect. Identifying significant predictor factors leading to third or fourth degree perineal tears during vaginal delivery was the objective of this study.

METHODS: During a two-year period (1995-1996), a third or fourth degree perineal rupture occurred in 214 women (3.7%) after vaginal delivery. Data from these deliveries were collected and compared to data from deliveries without anal sphincter tears in order to identify risk factors. A stepwise logistic regression model was used for the analysis.

RESULTS: Independent risk factors of significance were vaginal nulliparity, a squatting position on a delivery chair, maternal age exceeding 35 years, baby’s birth weight over 4000 g, vacuum extraction (both outlet and mid release), median episiotomy, oxytocin augmentation and birthing between 3 a.m. and 6 a.m.

CONCLUSIONS: This study identified several factors associated with anal sphincter tears. Median episiotomy should be avoided. Delivery, while squatting on a low chair, should be used with caution. A woman with one or more risk factors requires caution by birth attendants during delivery. Gynecologists should consider the option of cesarean section instead of vacuum extraction, especially when mid release is needed in the presence of macrosomia. A continuous audit regarding instrumental delivery technique is necessary.

Sumário (português)  :

Resumen (español)  :

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Argument (français) :

Etude pour déterminer les facteurs prédictifs des déchirures périnéales du 3ème et 4ème degré. Facteurs prédictifs : nulliparité, position accroupie sur chaise basse, âge maternel > 35 ans, poids du bébé > 4000g, vacuum extractors [both outlet and mid release], épisiotomie médiane, accélération du travail par oxytocine et naissance entre 3h et 6h du matin.

Argument (English):

Study to determine the predictive factors of third and fourth degree perineal tears. Predictive factors: nulliparity, crouching position on low chair, maternal age > 35 years, baby points > 4000g, median episiotomy, oxytocin acceleration and birth between 3am and 6am.

Argumento (português):

Estudo para determinar os fatores preditivos de rupturas perineais de terceiro e quarto graus. Fatores preditivos: nuliparidade, posição agachada na cadeira baixa, idade materna > 35 anos, bebê > 4000g, episiotomia mediana, aceleração da ocitocina e parto entre 3h e 6h.

Argumento (español):

Keywords :

➡ duration of labour ; evidence-based medicine/midwifery ; position during labor ; maternal age ; perineal/vaginal tears ; episiotomy ; active management of labor ; oxytocin ; hormones ; vacuum extraction (ventouse)

Author of this record :

Cécile Loup — 12 Jun 2004
➡ latest update : Bernard Bel — 05 Nov 2018

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