Subscribe to RSS
DOI: 10.1055/s-0041-1735227
Perineal Lacerations: A Retrospective Study in a Habitual-Risk Public Maternity
Lacerações perineais: um estudo retrospectivo em uma maternidade pública de risco habitualAbstract
Objective In around 85% of vaginal births, the parturients undergo perineal lacerations and/or episiotomy. The present study aimed to determine the incidence of lacerations and episiotomies among parturients in 2018 in a habitual-risk public maternity hospital in southern Brazil, and to determine the risk and protective factors for such events.
Methodology A retrospective cross-sectional study. Data were obtained from medical records and analyzed using the Stata software. Univariate and multivariate logistic regressions were performed. Values of p < 0.05 were considered significant.
Results In 2018, there were 525 vaginal births, 27.8% of which were attended by obstetricians, 70.7% by obstetric nurses, and 1.5% evolved without assistance. Overall, 55.2% of the parturients had some degree of laceration. The professional who attended the birth was a significant variable: a greater number of first- and second-degree lacerations, as well as more severe cases, occurred in births attended by nurses (odds ratio [OR]: 2,95; 95% confidence interval [95%CI]: 1,74 to 5,03). Positions at birth that did not enable perineal protection techniques (expulsive period with the “hands-off” method), when analyzed in isolation, determined the risk; however, in the final regression model, this relationship was not confirmed. Although reported in the literature, there were no associations between the occurrence of laceration and age, skin color, or birth weight. In 24% of the births, episiotomy was performed, and doctors performed 63.5% of them.
Conclusion Births attended by nurses resulted in an increased risk of perineal lacerations, of varying degrees. In turn, those assisted by physicians had a higher occurrence of episiotomy.
Resumo
Objetivo Aproximadamente 85% dos partos vaginais cursam ou com lacerações perineais e/ou com episiotomia. Este estudo objetivou determinar a incidência de lacerações e episiotomias das parturientes de 2018 de uma maternidade pública de risco habitual, no sul do Brasil, bem como determinar os fatores de risco e proteção para tais eventos.
Métodos Estudo transversal retrospectivo, no qual os dados foram obtidos dos prontuários e analisados no programa Stata. Realizaram-se regressões logísticas uni e multivariada. Foram considerados como significantes valores de p < 0,05.
Resultados Em 2018, aconteceram 525 partos vaginais, sendo 27,8% assistidos por médicos obstetras, 70,7%, por enfermeiros obstetras, e 1,5% evoluíram sem assistência. Ao todo, 55,2% das parturientes apresentaram algum grau de laceração. O profissional que assistiu ao parto foi uma variável que demonstrou significância: um maior número de lacerações de primeiro e segundo graus, bem como casos de maior gravidade, ocorreram em partos assistidos por enfermeiros (razão de probabilidades [RP]: 2,95; intervalo de confiança de 95% [IC 95%]: 1,74 a 5,03). Posições ao nascimento que não permitiam técnicas de proteção perineal (período expulsivo na técnica “sem mãos” [hands off, em inglês]), quando analisadas isoladamente, determinaram o risco; contudo, no modelo final de regressão, essa relação não se confirmou. Apesar de relatada na literatura, não houve associação entre a ocorrência de laceração e a idade, a cor da pele, ou o peso de nascimento. Em 24% dos partos, uma episiotomia foi realizada, tendo os médicos executado 63,5% delas.
Conclusão Partos assistidos por enfermeiros resultaram em um maior risco de lacerações perineais, de variados graus. Por sua vez, os assistidos por médicos apresentaram maior ocorrência de episiotomia.
Contributors
All of the authors participated in the concept and design of the study; analysis and interpretation of data; draft or revision of the manuscript; and they have approved the manuscript as submitted. All authors are responsible for the reported research.
Publication History
Received: 01 September 2020
Accepted: 21 July 2021
Article published online:
21 September 2021
© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Aquino CI, Guida M, Saccone G, Cruz Y, Vitagliano A, Zullo F. et al. Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2020; 33 (06) 1051-1063 DOI: 10.1080/14767058.2018.1512574.
- 2 Smith LA, Price N, Simonite V, Burns EE. Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy Childbirth 2013; 13: 59 DOI: 10.1186/1471-2393-13-59.
- 3 Bulchandani S, Watts E, Sucharitha A, Yates D, Ismail KM. Manual perineal support at the time of childbirth: a systematic review and meta-analysis. BJOG 2015; 122 (09) 1157-1165 DOI: 10.1111/1471-0528.13472.
- 4 Bick DE, Kettle C, Macdonald S, Thomas PW, Hills RK, Ismail KM. PErineal Assessment and Repair Longitudinal Study (PEARLS): protocol for a matched pair cluster trial. BMC Pregnancy Childbirth 2010; 10: 10 DOI: 10.1186/1471-2393-10-10.
- 5 Kettle C, Tohill S. Perineal care. BMJ Clin Evid 2008; 2008: 1401
- 6 Vale de Castro Monteiro M, Pereira GM, Aguiar RA, Azevedo RL, Correia-Junior MD, Reis ZS. Risk factors for severe obstetric perineal lacerations. Int Urogynecol J Pelvic Floor Dysfunct 2016; 27 (01) 61-67 DOI: 10.1007/s00192-015-2795-5.
- 7 Aguiar SV, Gonçalves ER, Bezerra LR. [Analysis of the incidence and prevalence of obstetric cause perineal laceration in a tertiary maternity hospital from Fortaleza-CE]. Rev Med UFC. 2019; 59 (01) 39-43 DOI: 10.20513/2447-6595.2019v59n1p39-43. Portuguese.
- 8 Ministério da Saúde. [National guidelines for delivery care: short version]. Brasília, DF: Ministry of Health Editor; 2017. . Portuguese.
- 9 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 165: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol 2016; 128 (01) e1-e15 DOI: 10.1097/AOG.0000000000001523.
- 10 Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev 2017; 2 (02) CD000081 DOI: 10.1002/14651858.CD000081.pub3.
- 11 Dahlen H, Priddis H, Schmied V, Sneddon A, Kettle C, Brown C. et al. Trends and risk factors for severe perineal trauma during childbirth in New South Wales between 2000 and 2008: a population-based data study. BMJ Open 2013; 3 (05) e002824 DOI: 10.1136/bmjopen-2013-002824.
- 12 The American College of Obstetricians and Gynecologists. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 198: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol 2018; 132 (03) e87-e102 DOI: 10.1097/AOG.0000000000002841.
- 13 Simic M, Cnattingius S, Petersson G, Sandström A, Stephansson O. Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study. BMC Pregnancy Childbirth 2017; 17 (01) 72 DOI: 10.1186/s12884-017-1251-6.
- 14 Aasheim V, Nilsen ABV, Reinar LM, Lukasse M. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev 2017; 6 (06) CD006672 DOI: 10.1002/14651858.CD006672.pub3.
- 15 Abedzadeh-Kalahroudi M, Talebian A, Sadat Z, Mesdaghinia E. Perineal trauma: incidence and its risk factors. J Obstet Gynaecol 2019; 39 (02) 206-211 DOI: 10.1080/01443615.2018.1476473.
- 16 Poulsen MØ, Madsen ML, Skriver-Møller AC, Overgaard C. Does the Finnish intervention prevent obstetric anal sphincter injuries? A systematic review of the literature. BMJ Open 2015; 5 (09) e008346 DOI: 10.1136/bmjopen-2015-008346.
- 17 Lins VML, Katz L, Vasconcelos FBL, Coutinho I, Amorim MM. Factors associated with spontaneous perineal lacerations in deliveries without episiotomy in a university maternity hospital in the city of Recife, Brazil: a cohort study. J Matern Fetal Neonatal Med 2019; 32 (18) 3062-3067 DOI: 10.1080/14767058.2018.1457639.
- 18 da Silva FM, de Oliveira SM, Bick D, Osava RH, Tuesta EF, Riesco ML. Risk factors for birth-related perineal trauma: a cross-sectional study in a birth centre. J Clin Nurs 2012; 21 (15-16): 2209-2218 DOI: 10.1111/j.1365-2702.2012.04133.x.
- 19 Corrêa Junior MD, Passini Júnior R. Selective episiotomy: indications, techinique, and association with severe perineal lacerations. Rev Bras Ginecol Obstet 2016; 38 (06) 301-307 DOI: 10.1055/s-0036-1584942.
- 20 Ogunyemi D, Manigat B, Marquis J, Bazargan M. Demographic variations and clinical associations of episiotomy and severe perineal lacerations in vaginal delivery. J Natl Med Assoc 2006; 98 (11) 1874-1881
- 21 Ott J, Gritsch E, Pils S, Kratschmar S, Promberger R, Seemann R. et al. A retrospective study on perineal lacerations in vaginal delivery and the individual performance of experienced mifwives. BMC Pregnancy Childbirth 2015; 15: 270 DOI: 10.1186/s12884-015-0703-0.
- 22 Schmitz T, Alberti C, Andriss B, Moutafoff C, Oury JF, Sibony O. Identification of women at high risk for severe perineal lacerations. Eur J Obstet Gynecol Reprod Biol 2014; 182: 11-15 DOI: 10.1016/j.ejogrb.2014.08.031.
- 23 Alperin M, Krohn MA, Parviainen K. Episiotomy and increase in the risk of obstetric laceration in a subsequent vaginal delivery. Obstet Gynecol 2008; 111 (06) 1274-1278 DOI: 10.1097/AOG.0b013e31816de899.
- 24 Manzanares S, Cobo D, Moreno-Martínez MD, Sánchez-Gila M, Pineda A. Risk of episiotomy and perineal lacerations recurring after first delivery. Birth 2013; 40 (04) 307-311 DOI: 10.1111/birt.12077.
- 25 Gåreberg B, Magnusson B, Sultan B, Wennerholm UB, Wennergren M, Hagberg H. Birth in standing position: a high frequency of third degree tears. Acta Obstet Gynecol Scand 1994; 73 (08) 630-633 DOI: 10.3109/00016349409013456.
- 26 World Health Organization. WHO recommendations intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and well-being. Geneva: WHO; 2018
- 27 Garretto D, Lin BB, Syn HL, Judge N, Beckerman K, Atallah F. et al. Obesity may be protective against severe perineal lacerations. J Obes 2016; 2016 (9376592): 1-5 DOI: 10.1155/2016/9376592.
- 28 Gün İ, Doğan B, Özdamar Ö. Long- and short-term complications of episiotomy. Turk J Obstet Gynecol 2016; 13 (03) 144-148 DOI: 10.4274/tjod.00087.
- 29 Kalis V, Laine K, de Leeuw JW, Ismail KM, Tincello DG. Classification of episiotomy: towards a standardisation of terminology. BJOG 2012; 119 (05) 522-526 DOI: 10.1111/j.1471-0528.2011.03268.x.
- 30 Frankman EA, Wang L, Bunker CH, Lowder JL. Episiotomy in the United States: has anything changed?. Am J Obstet Gynecol 2009; 200 (05) 573.e1-573.e7 DOI: 10.1016/j.ajog.2008.11.022.
- 31 Grigoriadis T, Athanasiou S, Zisou A, Antsaklis A. Episiotomy and perineal repair practices among obstetricians in Greece. Int J Gynaecol Obstet 2009; 106 (01) 27-29 DOI: 10.1016/j.ijgo.2009.03.013.
- 32 Carmo Leal Md, Pereira AP, Domingues RM, Theme Filha MM, Dias MA, Nakamura-Pereira M. et al. Obstetric interventions during labor and childbirth in Brazilian low-risk women. Cad Saude Publica 2014; 30 (Suppl. 01) S1-S16 DOI: 10.1590/0102-311X00151513.
- 33 World Health Organization. Care in normal birth: a practical guide: report of a technical working group. Geneva: WHO; 1996
- 34 Howard D, Davies PS, DeLancey JO, Small Y. Differences in perineal lacerations in black and white primiparas. Obstet Gynecol 2000; 96 (04) 622-624 DOI: 10.1016/s0029-7844(00)00956-x.