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Created on : 23 May 2005
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Third degree perineal tears in a university medical center where midline episiotomies are not performed. Archives of Gynecology and Obstetrics 2005;271(4):307-310.

Author(s) :

Sheiner E, Levy A, Walfisch A, Hallak M, Mazor M.

Year of publication :

2005

URL(s) :

http://springerlink.metapress.com/media/3846WJMQWQ…

Résumé (français)  :

Abstract (English)  :

OBJECTIVE: Midline episiotomy is a known major risk factor for severe perineal lacerations. The study was aimed to define obstetric risk factors for third-degree perineal tears in a university medical center where midline episiotomies are not performed.

STUDY DESIGN: A comparison between vaginal deliveries complicated with third-degree perineal tears and deliveries without third-degree perineal tears was performed. Deliveries occurred between the years 1988–1999 in a tertiary medical center. Multiple gestations, preterm deliveries (<37 weeks gestation), cesarean deliveries and cases of shoulder dystocia were excluded from the analysis. A multiple logistic regression model was constructed in order to find independent risk factors for third-degree perineal tears. Odds ratios (OR) and their 95% confidence interval (CI) were calculated from the regression coefficient.

RESULTS: During the study period, 79 (0.1%) consecutive cases of third degree perineal tears were identified. Significant risk factors from the univariate analysis were fetal macrosomia (OR 2.7, 95%CI 1.2–5.5), nulliparity (OR 2.9, 95%CI 1.8–4.6), labor induction (OR 1.9, 95%CI 1.0–3.5), failure of labor to progress during the second stage (OR 10.8, 95%CI 5.4–21.1), non-reassuring fetal heart rate patterns (OR 11.7, 95%CI 6.1–21.5), mediolateral episiotomy (OR 2.8, 95%CI 1.8–4.5), vacuum extraction (OR 10.6, 95%CI 6.1–18.3), and forceps delivery (OR 29.2, 95%CI 7.3–97.2). However, using a multivariable analysis, only fetal macrosomia (OR 2.5, 95%CI 1.2–4.9), vacuum extraction (OR 8.2, 95%CI 4.7–14.5), and forceps delivery (OR 26.7, 95%CI 8.0–88.5) remained as independent risk factors. The combined risk for instrumental deliveries of macrosomic newborns was 8.6 (95% CI 1.2–62.5; p=0.010).

CONCLUSIONS: After adjustment for possible confounding variables, mediolateral episiotomy per se was not an independent risk factor for third-degree perineal tears. Instrumental vaginal deliveries of macrosomic fetuses should be avoided whenever possible to decrease the occurrence of third-degree perineal tears.

Sumário (português)  :

Resumen (español)  :

Full text (private) :

Comments :

Texte en accès libre. Ce n’est pas un article original, le même contenu avait déjà été publié dans un autre journal. Le taux particulièrement bas de déchirures sévères, 0.1%, soit 79 cas en 11 ans, jette quelque suspicion sur leurs résultats statistiques, ce qui est bien dommage. Les auteurs en conviennent eux-mêmes dans la discussion d’ailleurs.

Argument (français) :

Les facteurs de risque indépendants de déchirures sévères du périnée sont les extractions instrumentales et la macrosomie.

Argument (English):

Argumento (português):

Argumento (español):

Keywords :

➡ evidence-based medicine/midwifery ; perineal/vaginal tears ; episiotomy ; instrumental delivery ; forceps delivery ; vacuum extraction (ventouse) ; induction of labor ; post-term pregnancy

Author of this record :

Cécile Loup — 23 May 2005