Abstract
BackgroundWe sought to investigate the impact of the duration of second stage of labor on risk of severe perineal lacerations (third and fourth degree).MethodsThis 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).ResultsRisk 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.ConclusionsThe 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.
Highlights
We sought to investigate the impact of the duration of second stage of labor on risk of severe perineal lacerations
Depending on the anatomical structures involved, severe perineal lacerations fall into two categories: third-degree lacerations, which involve the anal sphincter complex, and fourth-degree lacerations, which extend to the rectal mucosa
Prolonged second stage of labor has been associated with risks of adverse maternal outcomes, including severe perineal lacerations [8, 11,12,13,14,15,16]
Summary
We sought to investigate the impact of the duration of second stage of labor on risk of severe perineal lacerations (third and fourth degree). Prolonged second stage of labor has been associated with risks of adverse maternal outcomes, including severe perineal lacerations [8, 11,12,13,14,15,16]. These studies have methodological limitations, including oversimplified categorization of second stage of labor, lack of information on study population characteristics and control of confounding [11, 15]. No previous study has used prospectively recorded information to investigate the duration of the second stage of labor as an independent risk factor for severe perineal lacerations, taking important maternal and delivery characteristics into account
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