Abstract

Objective. To determine if there is an association between BMI and 3rd- or 4th-degree perineal lacerations in normal spontaneous and operative vaginal deliveries. Study Design. We performed a retrospective case control study using a large obstetric quality improvement database over a six-year period. Cases were identified as singleton gestations with third- and fourth-degree lacerations. Controls were obtained randomly from the database of patients without third- or fourth-degree lacerations in a 1 : 1 ratio. Univariate and multivariate logistic regression analyses were performed. Results. Of 32,607 deliveries, 22,011 (67.5%) charts with BMI documented were identified. Third- or fourth-degree lacerations occurred in 2.74% (n = 605) of patients. 37% (n = 223) were identified in operative vaginal deliveries. In the univariate analysis, obesity, older maternal age, non-Asian race, and birth weight <4000 g were all protective against 3rd- and 4th-degree lacerations. After controlling for age, race, mode of vaginal delivery, and birth weight, obesity remained significant. Conclusion. Being obese may protect against third- and fourth-degree lacerations independent of parity, race, birth weight, and mode of delivery.

Highlights

  • Obesity has reached epidemic proportions and affects most countries in the world

  • Severe perineal lacerations are a serious complication of childbirth that can have both short and long term implications [5]

  • Univariate analysis revealed that obesity, race, operative vaginal delivery, parity, birth weight, oxytocin use, shoulder dystocia, and length of second stage were all significantly associated with severe perineal lacerations

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Summary

Introduction

Obesity has reached epidemic proportions and affects most countries in the world. Obesity in the United States remains high at 36.5% of reproductive-age women of all ethnicities in 2012; 17% are class II or III obese, defined as BMI 35– 39.9 kg/m2 and BMI of at least 40 kg/m2, respectively [1]. Given the variety of other risks obese women face during pregnancy (e.g., hypertensive disorders, gestational diabetes, complications of cesarean delivery, and fetal growth disturbances) [2,3,4], a more complete knowledge of what other risks they may encounter is invaluable. Severe perineal lacerations are a serious complication of childbirth that can have both short and long term implications (e.g., incontinence, dyspareunia, acute and chronic pain, and even choice of cesarean delivery in subsequent pregnancies) [5]. Quality control measurements of hospitals include third- and fourth-degree perineal lacerations, even though there may be patient characteristics that are unable to be controlled. Reported risk factors for third- and fourth-degree lacerations include Asian race, nulliparity, midline episiotomy, older maternal age, larger newborn birth weight, and assisted vaginal deliveries [6, 7].

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