Abstract
Despite all the medical care provided during delivery labor, perineal injury is still prevalent and may lead to diverse pelvic floor disorders. The aim here was to investigate the prevalence of obstetric and anal sphincter injuries (OASIS) in healthy pregnant women after vaginal delivery. Cross-sectional study involving 3,034 patients with singletons in a secondary hospital for low-risk cases. A standardized questionnaire was prepared and applied to medical files that had been completely filled out (classification of the Royal College of Obstetricians and Gynecologists, RCOG) in order to identify OASIS and analyze risk factors associated with mild and severe perineal lacerations. The women's mean age was 25 years; more than half (54.4%) were primiparae. Almost 38% of the participants had perineal lacerations; these were severe in 0.9% of the cases. Previous vaginal delivery (odds ratio, OR: 1.64 [1.33-2.04]) and forceps delivery (OR: 2.04 [1.39-2.97]) were risk factors associated with mild perineal injuries (1st and 2nd OASIS classifications). Only remaining standing for prolonged periods during professional activity (OR: 2.85 [1.34-6.09]) was associated with severe perineal injuries. The prevalence of severe perineal injuries was concordant with data in the literature. The variable of standing position was considered to be a risk factor for severe perineal injury and should be further investigated.
Highlights
Perineal tears may occur after vaginal delivery
The following variables influenced the type of laceration: the maternal variables of age, body position during professional activity, body mass index (BMI) and at least one previous vaginal delivery; the obstetric variables of use of oxytocin, time of membrane rupture, duration of the second period, episiotomy, locoregional analgesia and assisted vaginal delivery; and the neonatal variable of cranial circumference
We found that the prevalence of severe perineal tears was 0.9% in our cohort, which can be considered low in comparison with some previous studies[14,15] but similar to or higher than values reported from other samples.[16,17]
Summary
Perineal tears may occur after vaginal delivery. This event may lead to fecal and urinary incontinence, chronic pelvic pain and dyspareunia in young women.[1] Epidemiological studies have demonstrated that perineal trauma correlates with maternal, fetal and birth delivery factors.[1] Classifications for these complications have been devised[1] and they have been named obstetric and anal sphincter injuries (OASIS) by urogynecologists and obstetricians. The birth factors of prolonged second stage of labor,[7,10] birth analgesia,[11,12] episiotomy[13] and assisted vaginal delivery[4,6,7] increase the risk of perineal trauma
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Schedule a callMore From: Sao Paulo medical journal = Revista paulista de medicina
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