Abstract
Romania is a country with high rates of adolescent births, associating scarce comprehensive obstetrical management with this specific population. This research aims to assess soft tissue trauma after vaginal birth in teenage mothers compared to their adult counterparts. A retrospective case-control study was conducted for one year in two hospitals. All vaginal deliveries were considered; the age cut-off value was considered at 20 years old for case and control groups. Lacerations were divided into three subgroups, considering the involved anatomical region; group I: labial and periurethral lacerations, group II: vaginal and perineal lacerations, and group III: cervical lacerations. There were 1498 women included in the study: 298 young mothers and 1200 adults. Teenagers were more likely to have an episiotomy during vaginal delivery compared to adult women: 56% versus 26.7% (p = 0.00, Pearson Chi-square) and a 1.89 times increased risk for developing additional group II lacerations: p = 0.01, Pearson Chi-square test with Bonferroni correction: OR = 1.89, 95% CI: 1.18–3.02. Group II lacerations were the most frequent type of birth trauma in both study groups. Fetal weight ≥4000 g was associated with a two times higher risk for vaginal and perineal lacerations when age criterion was not considered (OR = 1.98, 95% CI: 1.13–3.47, p = 0.01). The incidence of group I and II lacerations increased with age: from 0% and 9.1% between 10 and 14 years old to 6% and 26.2% between 18 and 19 years old. All groups of lacerations were more often identified in the case group, compared to the adult group. Fetal macrosomia and spontaneously ruptured membranes at admission could not be documented as risk factors for obstetrical injury in young mothers. Episiotomy performed in teenagers was not a protective procedure for group II lacerations.
Highlights
Fetal weight ≥4000 g was assessed as a possible risk factor for soft tissue trauma during vaginal birth and we identified a two times higher risk of group II lacerations when age criterion was not considered (OR = 1.98, 95% confidence interval (CI): 1.13–3.47, p = 0.01)
Among Romanian mothers who have spontaneous vaginal birth, the high rates of episiotomy are an indicative marker of continuous unselective use
The incidence of episiotomy tended to decrease with maternal age
Summary
The age of European women who bear children varies widely. Related to different etiologies, maternal morbidity and mortality rates are highest among the youngest and oldest women [1]. Statistical reports show that 9.7% of Romanian births in 2015 were attributed to women younger than 20 years of age while at the same time, having children later in life is a general trend across the entire continent [1]. In Romania, vaginal births account for 55.9% of all deliveries the country ranks second after Cyprus among European Union countries concerning rates of caesarean sections [2]. Evidence shows that countries reporting high rates of caesarean deliveries
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