Perineal Lesions Research Articles

Pulsating electromagnetic fields for perineal lacerations and surgical wounds healing in the postpartum: a pilot study

PurposeThe aim of our study was to assess the possible benefits of Therapeutic Magnetic Resonance (TMR) in the treatment of spontaneous perineal lacerations and episiotomies in the postpartum.MethodsWe performed a prospective, non-pharmacologic, non-profit, monocentric interventional study on women who had a spontaneous laceration and/or an episiotomy at delivery. The TMR device treatment was accepted by 52 women, while 120 women underwent standard care. Patients were visited 1 day postpartum, before starting the treatment; then a follow-up visit was performed at 3 weeks, 5 weeks, and 3 months after delivery. The main endpoint was the time required for complete healing of the laceration and/or the episiotomy. Secondary endpoints were the prevalence of dehiscence, infections, urinary discomfort, urinary leakage, and the quality of restoration of sexual function.ResultsIn the treatment group the REEDA score was significantly better both at 3- and 5-weeks postpartum follow-up. At 3 weeks and 5 weeks postpartum, we observed a significantly better outcome in the treatment group for all subjective complaints and perineal complications associated with lacerations and episiotomies. The percentage of patients who scored above the cutoff for sexual dysfunction was significantly better in the treatment group (83.3%) than in the control group (31.8%) (p < 0.001).ConclusionsWith this pilot study, we introduced low dose Pulsating Electromagnetic Fields (PEMFs) as a novel conservative and not pharmacological approach to reduce complications of perineal lesions. Our results demonstrated to significantly improve perineal wound healing and to ameliorate the sexual function in the postpartum.

Utility of Sensate Pedicled Medial Thigh Perforator Flaps in Treating Recurrent Ischial Ulcers in Individuals with Cauda Equina Lesions and Spinal Dysraphism – A Retrospective Analysis

Abstract Background: Ischial pressure ulcers pose a significant challenge due to their high recurrence rates. It is imperative to provide or establish a reliable, well-vascularized soft-tissue cover over the ischial area to prevent recurrences. The objective of the study was to study the utility and complication rates associated with pedicled medial thigh perforator (P-MTP) sensate flap procedures in managing recurrent ischial ulcers and perineal lesions. Methods: A retrospective cohort study was conducted at Christian Medical College, Vellore, a tertiary care center in South India. This study involved 30 patients with ischial pressure sores. Of these, 13 patients underwent P-MTP flaps, while 17 underwent alternative surgeries for ulcer closure (January 2014–June 2020). Results: Among 13 patients who underwent P-MTP sensate flaps, 1 major complication (full-thickness flap necrosis) necessitated flap revision, while 6 minor complications occurred in the postoperative period. Three patients (23.08%) reported late recurrence of ulcers at the same postoperative site. In contrast, among the 17 patients who underwent the other (alternative) methods of surgical closure, 3 patients had wound dehiscence in the postoperative period. Four patients reported recurrence of ulcer at the postoperative site within 6 months and another four after 6 months of surgical closure. The surgical outcomes in sensate flap surgeries (P-MTP flaps) were comparable to other approaches for surgical closure. Sensation in the P-MTP flap transposed over the ischial region remained intact in all 13 patients at 6-month follow-up. Conclusion: The P-MTP sensate flap is a feasible and reliable treatment strategy for regional soft-tissue reconstruction in ischial and perineal lesions with postoperative complications comparable to other surgical methods for ischial ulcer closure. The sensate flap surgeries offer the additional benefit of maintaining intact sensation over the pressure injury vulnerable ischial region.

Common and uncommon lesions of the vulva and vagina on magnetic resonance imaging: correlations with pathological findings.

Vulvar and vaginal lesions representing a wide spectrum of diseases in female lower genital tract diseases make up a small part of all gynecological etiologies. Many of them are rare etiologies and are reported in case-reports studies. Translabial and transperineal ultrasound are modalities of choice for the first evaluation of perineal lesions. MRI is usually performed to determine the etiology of the lesions and stage. Benign lesions of the vulva and vagina usually manifest as simple cystic (vestibular cyst or endometrioma) or solid lesions (leiomyoma or angiofibroblastoma), while malignancies usually appear as large, solid masses and fill into both vaginal and perineal area. Post-contrast images play an important role in establishing a differential diagnosis, however, some benign lesions can also exhibit a vivid enhancement. Knowledge about radiologic-associated pathological manifestations may aid clinicians in better understanding these pathologies, especially for some rare lesions, and making a proper diagnosis before invasive procedures.

P145 Phenotypic progression of Crohn’s disease : assessment of risk factors in a Tunisian population

Abstract Background Phenotype progression in patients with Crohn’s disease (CD) is common, but its risk factors vary between studies. The knowledge of these factors at diagnosis help to identify patients with high risk to progression. These patients should be given aggressive treatments given early in the disease course. The aim of our study was to evaluate the long-term behavioral course of Crohn's disease and to determine predictive factors for phenotypic progression. Methods We conducted a retrospective, descriptive study including patients with Crohn's disease that were managed at our department, over a 9-year period [January 2011 - January 2020]. Patients with less than 2 years of follow-up were excluded. We screened for factors associated with phenotypic progression during follow-up by a univariate study. By binary logistic regression, we sought for factors independently related to phenotypic progression, including variables that had a p &amp;lt;0.2 in univariate study. Results We included 341 patients with a sex ratio of 1.05. The median age at diagnosis of CD was 31 years. Smoking was observed in 36.4% of patients and 16.5% were alcohol users. Forty-four patients (12.9%) had a family history of Inflammatory Bowel Disease and 5.3% had associated autoimmune diseases. The mean BMI of the patients was 20.57 ± 4.5 kg/m². Seventy-six patients were at least overweighted at the time of diagnosis. The disease was classified as ileal, colonic and ileocolic in 150, 86 and 99 patients respectively. The involvement of the upper gastrointestinal (GI) tract was noted in 49 patients (14.36%) and 84 patients (24.6%) had perineal lesions mainly complex fistulas (17.3%). CD was initially classified as inflammatory, stricturing and fistulizing in 71%, 17% and 11% respectively. Phenotypic progression during follow-up was observed in 33 patients (9.6%), finally classifying the disease as inflammatory in 41%, stricturing in 22% and fistulizing in 35% of cases. In univariate study, the factors associated with phenotypic progression were represented by isolated ileal location (p=0.028, OR=2.28), the presence of perineal fistulas (p=0.006, OR=3.07) and hypoalbuminemia at diagnosis of less than 27.94g/L (p=0.035). Extensive ileal involvement and the presence of granuloma on histology were not associated with phenotypic progression. In multivariate study, only initial upper GI tract’s involvement was an independent predictor of phenotypic progression (p=0.024. OR=0.11, IC[0.18-0.75]). Conclusion Our study showed that upper GI tract’s involvement was the main predictor of phenotypic progression in CD.

Socio-Epidemiological Aspects and Prognosis of Unassisted Deliveries Arriving at Fousseyni Daou Hospital in Kayes

Introduction: The World Health Organization estimates that each year more than 20 million women suffer from the after-effects of unattended childbirth, of which 800 women die every day as a result of obstetric complications. Objective: Study the socio-epidemiological aspects and prognosis of unassisted deliveries arriving at the Fousseyni Daou De Kayes hospital. Materials and Methods: This was a descriptive, cross-sectional study with prospective collection, case-control that took place at the maternity ward of the Fousseyni Daou hospital in Kayes, from 1 January to 31 December 2021. Results: The frequency of unattended birth was 4.1%. The 30 - 35 age group was the most represented with 32.5%. In our study 58.1% of cases were out of school, 19.4% were primigestes and 39.4% were multiparous. In our series 60.6% of cases had given birth at home and 39.4% along the way. The majority of cases regretted having given birth without the assistance of qualified personnel in 45.6%. Maternal complications were dominated by perineal lesions in 14.4% of cases, haemorrhage of delivery in 25% of cases, severe anaemia in 30% of cases; 16.7% of newborns were in poor condition, 13.6% were fresh stillbirths, 15.6% of newborns had obstetric trauma. The maternal death rate on arrival was 3%. Conclusion: The frequency of unassisted childbirth is high in the Kayes region. Its complications can be serious for both the mother and the newborn.

Pseudoepitheliomatous Hyperplasia: Harbinger of Underlying Squamous Cell Carcinoma - Lessons Learnt

Pseudoepitheliomatous hyperplasia (PEH) is a benign condition marked by reactive epithelial proliferation seen in response to various insults like trauma, infection, persistent inflammation and neoplasia. In this report, we discuss a case of a 35-year-old man who presented with a perineal swelling, later turned into a non-healing ulcer, first diagnosed as PEH. Still, after clinical suspicion, a deeper biopsy was conducted, confirming the diagnosis of squamous cell carcinoma and directing treatment appropriately. Non-healing perineal lesions are not uncommon. Most of the lesions turn out to be Squamous Cell Carcinoma. But, if the histopathological picture suggests Pseudoepitheliomatous Hyperplasia, it is vital to consider the limitations of the biopsy, and a solid clinicopathological correlation is required to look aggressively for underlying Squamous Cell Carcinoma. Due to the benign nature of PEH, most cases are treated via excision biopsy, while grafts or flaps are occasionally required to restore severe tissue defects. It is therefore crucial to rule out and distinguish this condition from other benign and malignant conditions, as the treatment and prognosis differ widely. It is of utmost importance to sample the base of the lesion, analyze multiple sections, and consider clinical data to ensure an accurate diagnosis.

Impact of Crohn's disease on obstetrical management

ObjectivePatients with Crohn's disease (CD) may have perineal lesions or a history of anorectal surgery that raise concerns about complications during delivery resulting in a discussion of cesarean section. Our objective was to study the impact of CD on the mode of delivery. MethodWe conducted a retrospective study between 2005 and 2019 of the pregnancy outcomes of patients with CD. The primary endpoint was the performance of a cesarean section for a reason related to CD. ResultsAmong 76 consecutive pregnancies, 19 patients underwent CD-related cesarean section (25%). The main element associated with scheduling a cesarean section was the existence of perineal involvement in 94.7% of cases, compared to 12.3% in the rest of the CD population (p<0.05). The perineal lesions most often involved were fistulas (47.4% versus 1.7%; p = 0.042). There was a history of perineal surgery in 78.9% of cases in the cesarean group vs 10,5% (p < 0.05) and a history of obstetric anal sphincter injury (OASI) in 10.5% of cases vs. 0 (p = 0.047). In women who gave birth vaginally, there were 17.9% episiotomy and one case of OASI (2.6%). ConclusionThe factors that influenced the choice of delivery route were perineal damage, history of perineal surgery and history of OASI.

Rectal Cancer - An Unrecognised Complication of Crohn's Disease: Case Report

Crohn's disease is a frequent and invalidating pathology. The development of colorectal cancer in long- standing Crohn's disease patients has become a major complication, but which unfortunately is underestimated and not so much evaluated in current practice. And to underline this and remind clinicians of it we present our case. This article presents a patient with Crohn's disease who experienced the two known complications, severe acute colitis and ano- perineal lesions, and who developed invasive adenocarcinoma on the rectum remaining 20 years after subtotal colectomy.

Lesioni perineali benigne nel neonato

The authors present the case of a term newborn with a perineal groove and the case of a newborn with a so-called Infantile Perianal Pyramidal Protrusion (IPPP). The differential diagnosis of perineal lesions in newborns is also discussed

Evaluation of the sexual desire disorders in the post-partum period

ABSTRACT Introduction A woman's sexuality changes throughout her life and varies according to endogenous and exogenous factors. In this perspective, pregnancy and childbirth create a state of sexual desire dysfunction. Eastern culture has always dissociated parents from their intimate life, making the resumption of postpartum sexuality more taboo. Objectives To study women's sexual desire disorders after childbirth in order to identify factors that influence it. Methods Prospective, cross-sectional study over 200 women followed from the third trimester of the pregnancy until the 6th month postpartum. The evaluation of sexual desire was based on the parameters of the FSFI score (Female Sexual Function Index) in Arabic version. Results The average age of the women in our study was 31 years with extremes ranging from 15 to 45 years. The mean parity was 2.4 with extremes ranging from 1 to 4. 94% of our patients were married. 56% of the study population delivered vaginally, of whom 6% required instrumental extraction.20% had a scheduled cesarean section, and 24% had an emergency cesarean section during labor. Over the half the population (56%) did not use any contraception after delivery. 32% opted for the combined pill, while 10% used condoms and 2% had a tubal ligation during cesarean delivery.46% of women breastfed their childs. A decrease in sexual desire has been reported in the postpartum period. At the FSFI, the mean score of the sexual desire before childbirth was 3,33. A minimum sexual desire score of 1,2 was noted in 12% of the women, and 4% of the women had a maximum sexual desire score of 6.After childbirth, the mean score was 3.25. with a minimum of 1,2 noted in 8% of women, and a maximum of 6 found in 4% of women. Regarding the frequency of sexual desire,46% of women reported having sexual desire less than half the time (38%) or almost never (8%). During pregnancy, this rate was 38%.The qualitative evaluation of sexual desire found that 46% of women reported a feeling of decreased sexual desire, whereas this disorder affected 40% of the population before delivery. On the other hand, 26% of women reported a high sexual desire. The occurrence of sexual desire and its intensity were correlated with the following parameters: marital status, breastfeeding, route of delivery and the presence of perineal lesions. Conclusion The postpartum period is accompanied by physical and psychological changes that affect female sexual function. A medical approach to the evaluation of sexual desire disorders must be lead in order to identify their cause's and treat them. Disclosure Work supported by industry: no.

Delivery of macrosomia in a Cameroonian referral facility: epidemiological, clinical, therapeutic and prognostic aspects

Introduction: Macrosomia represents a high-risk obstetrical situation because it is at the origin of an important maternal-fetal morbidity through its numerous complications, reason for which it would put at risk the maternal-fetal vital prognosis. However, few studies have been carried out in our environment, hence the need to contextualize and update the data. Objective: Our objective was to study the epidemiological, clinical and therapeutic aspects of the delivery of macrosomia at the Gynaecological-Obstetric and Paediatric Hospital of Yaoundé. Methodology: This was a descriptive cross-sectional study with prospective data collection at the Gynaecological-Obstetric and Paediatric Hospital in Yaoundé. The recruitment period was spread over 4 months, from 03 January to 07 May 2021. Thus, we included in our study, women who delivered a macrosomic newborn and gave their informed consent for the study. The data collected were analyzed using SPSS version 22.0 software. Results: In total, we included 52 participants. We obtained a frequency of 6.23% of macrosomal deliveries at the HGOPY. The most represented age group was between 25 and 30 years for an average age of 29 years.Diabetes was found in a small proportion (1.9%), Obesity was found in 12% of cases. Induction of labour was necessary in 13% of cases. Uterine heights between 34 and 37 cm were predominant in 56% of cases. Multiparous women were the most common in 32% of cases, and postterm in 7% of cases. The most common presentation was cephalic at 92%. Caesarean section was necessary in 37% of cases and occurred mostly in emergency at 85% and the use of oxytocin was the majority. Complications at delivery were dominated by perineal lesions in 70% of cases and delivery haemorrhage in 60% of cases. We observed 92% of macrosomic newborns with a weight between 4000 and 4499 grams. Male sex was predominant in 72%. Fetal complications occurred in 11% of cases and were dominated by hypoglycemia and fetal death in utero. We did not record any neonatal or maternal deaths. Conclusion: Macrosomia is common in our study site. It mainly concerns women from the western region, with an average age of 30 years. The rate of caesarean section is high allowing the birth of a boy in the majority of cases. Maternal complications are dominated by perineal lesions and delivery haemorrhage, fetal complications by in utero fetal death and hypoglycaemia. Perinatal mortality is high.

Fibroma of perineum, a rare entity in children: Two congenital cases

Two cases of perineal polypoid-like lesions in children are described. The first patient is a 21 months old girl with a congenital perianal pedunculated asymptomatic lesion, covered by normal skin, not increased in size since birth (Figure 1). A MRI showed a lesion localized at right side of median raphe, in contact with external anal sphincter, without any apparently fistula and no dystrophy of raphe or sacrum (Figure 2). A surgical resection was performed. Histological examination revealed a soft fibroma. Post-operative period did not presented complications or recurrence. The second patient is a 7 months old girl derived to Pediatric Surgery Department of Verona Hospital for the presence of a mass localized in the left labium majus (Figure 3). The lesion was soft, pedunculated, asymptomatic and it has been increased in size since birth.

Introduction de la manœuvre de Couder et évolution des lésions périnéales

ObjectiveTo analyse the introduction of the Couder manoeuvre in our level 3 maternity unit shortly after its introduction in 2019. Then, to evaluate and compare the rate of perineal injuries between 2017, when the manoeuvre was not performed at all, and 2020. Materials and methodA single-centre retrospective study of patients who delivered a singleton eutociously at term from 1 January to 31 December 2017 and 2020. ResultsIn total, 2930 records were analysed. The Couder manoeuvre rate was 32.12% in 2020. A change in the distribution of perineal lesions was observed: the rate of intact perineum increased (P<0.001), while 2nd degree lesions decreased between 2017 and 2020 (P<0.05). The 1st degree perineum and obstetric anal sphincter injuries remained stable. The rate of episiotomy decreased significantly by almost a factor of 7. ConclusionThe practice of the Couder manoeuvre can be implemented fairly quickly after training of the actors with nearly a third of normal deliveries at term concerned one year after its introduction. This manoeuvre seems, in our practice, to have contributed to the reduction, as previously reported, of the rate of second degree perineal injuries.

Differential Diagnosis Between Perianal Crohn's Disease and Hidradenitis Suppurativa: A Challenging Teamwork.

Hidradenitis suppurativa (HS) is a rare, debilitating skin disease characterized by the presence of recurrent tender subcutaneous nodules that develop into abscesses and fistulae. Isolated perineal Crohn's disease (CD) is unusual, diagnosis can be difficult, and distinction from HS is a challenge for the gastroenterologist. The aim of this work was to determine the criteria that distinguish perineal CD from perineal HS. Four patients with isolated perineal CD and three with perineal HS were included. Rectal or skin biopsies of all CD patients showed granulomas. No granulomas were found for HS. Fistulae were present in 4/4 CD, extended to the anal canal. All patients with HS had gluteal abscesses. They were bilateral in all cases, superficial. Perineal lesions management should involve a multidisciplinary approach in order to make an accurate diagnosis and ultimately to give the best and most effective treatment.

Assessment of the impact of an expectant management in case of abnormally progressing first-stage labor

ObjectiveTo compare the cesarean section rate before and after the introduction of an expectant management protocol in patients with abnormally progressing first-stage labor. MethodsA prospective monocentric cohort study performed between January 2012 and July 2016. Results267 patients were included, 97 in the control group and 170 in the study group. The number of cesarean sections decreased from 86 % to 45 % (p < 0.001). The number of instrumental extractions increased from 8.3% to 29.4% (p < 0.001). The number of postpartum hemorrhages increased from 5.2% to 18% (p < 0.01). No differences in the rates of perineal lesions, neonatal pHa below 7.10, and shoulder dystocia were observed. ConclusionThe expectant management in patients with labor arrest in the first stage was associated with a decrease in the number of cesarean sections, at the cost of an increase in instrumental extractions and postpartum hemorrhages.

Republication de : Risque périnéal et mesures de protection obstétricale : enquête auprès des professionnels de la naissance

ObjectivesThe main objective was to evaluate the practices declared by birth professionals in the Lorraine region about perineal obstetric protection (any perineal tear combined). The secondary objective was to evaluate prevention measures performed in practice by birth professionals according to the perineal risk subjectively estimated for each obstetric situation. MethodsThis is a practice survey conducted through an anonymous questionnaire distributed to birth professionals (gynecologists, interns, midwife and midwife student) in October 2016. Topics covered concerned maternal, obstetric and fetal risk factors associated with perineal (1st to 4th degrees) lesions and the associated protective measures. A descriptive analysis of the data collected was conducted. ResultsOne hundred and five professionals answered the questionnaire. The identified risk factors were consistent with those highlighted in the literature. Other factors, not known as associated with perineal risk, were cited by professionals (smoking, phototype). If the professional perceived a significant perineal risk, they more frequently practiced an episiotomy (15% vs. 0%, P<0.001) or considered that the delivery should be performed by an obstetrician (34% vs 8%, P<0.001). ConclusionThis evaluation shows that birth professionals know the main risk factors for perineal injury. On the other hand, they easily use perineal protection maneuvers (episiotomy for example) without real demonstrated effectiveness.

Vulvovaginal manifestations in Stevens-Johnson syndrome and toxic epidermal necrolysis: Prevention and treatment

The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis can be as high as 70%; up to 28% of female patients will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecologic sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae, including erosions, scar formation, chronic skin changes, urethral complications, adenosis, malignant transformation, vulvodynia, and dyspareunia. We provide comprehensive recommendations for acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Treatment should include an ultrapotent topical steroid, followed by a nonirritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults (but should be avoided in prepubertal adolescents) with vaginal involvement. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Last, referrals for pelvic floor physical therapy and to surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients.

Risque périnéal et mesures de protection obstétricale : enquête auprès des professionnels de la naissance

ObjectivesThe main objective was to evaluate the practices declared by birth professionals in the Lorraine region about perineal obstetric protection (any perineal tear combined). The secondary objective was to evaluate prevention measures performed in practice by birth professionals according to the perineal risk subjectively estimated for each obstetric situation. MethodsThis is a practice survey conducted through an anonymous questionnaire distributed to birth professionals (gynecologists, interns, midwife and midwife student) in October 2016. Topics covered concerned maternal, obstetric and fetal risk factors associated with perineal (1st to 4th degrees) lesions and the associated protective measures. A descriptive analysis of the data collected was conducted. ResultsOne hundred and five professionals answered the questionnaire. The identified risk factors were consistent with those highlighted in the literature. Other factors, not known as associated with perineal risk, were cited by professionals (smoking, phototype). If the professional perceived a significant perineal risk, they more frequently practiced an episiotomy (15% vs. 0%, P<0.001) or considered that the delivery should be performed by an obstetrician (34% vs 8%, P<0.001). ConclusionThis evaluation shows that birth professionals know the main risk factors for perineal injury. On the other hand, they easily use perineal protection maneuvers (episiotomy for example) without real demonstrated effectiveness.

The study and use of Episiotomy Evaluation Form in the restrictive use of episiotomy

Objective To be good for the different working age midwives to carry out the same evaluation of the pregnant woman, we build and use the Episiotomy Evaluation Form for reducing the rate of episiotomy with ensuring the safety of mother and baby. Methods Consult relevant literature, combine clinical practice, discuss, report to the hospital ethics committee many times and at last it was made after approval. The details included: perineal lesions, perineum elasticity, perineal length, maternal coordination, gestational age, age, fetal distress degree, amniotic fluid situation, the weight of fetus estimated, the second time of labor and so on,to score by 0, 1, 3, 5, 20. A total of 600 patients with low risk of natural childbirth were randomly divided into observation group and control group according to method of random number table with 300 cases each.The observation group was graded according to the perineal incision evaluation and we operated according to its use method. The control group was judged according to the experience of midwife and subjective cognition. At last compared the effects on the mother and baby. Results The rates of lateral episiotomy and I degree laceration were 15.00% (45/300) and 63.00% (189/300) in the observation group and 48.33% (145/300) and 21.67% (65/300) in the control group, respectively. The difference between the two groups was statistically significant (χ2=16.238, 21.507, P 0.05). Conclusions By using the episiotomy evaluation form, we can improve the accuracy and homogeneity of the midwife's assessment about the episiotomy which is benefit to reduce rate of episiotomy. It is worth promoting in clinical practice but we should ensure the safety of maternal and child. Key words: Episiotomy Evaluation Form; Restrictive use of episiotomy

Lésions obstétricales du sphincter de l’anus et ventouse obstétricale chez des primipares à terme

ObjectivesOperative Vaginal Delivery (OVD) is subject to a risk of perineal tears especially of Obstetrical Anal Sphincter Injuries (OASIS) that are associated with more complications and impaired quality of life. The main objective of this study was to compare the rate of OASIS in primipara at term with fetus in cephalic presentation depending on the type of delivery: OVD using vacuum extractor and spontaneous delivery. MethodsThis is a single-center retrospective study between 01/01/2010 and 12/31/2014 including all primipara who delivered vaginally at term, a single and living fetus in cephalic presentation. Perineal lesions were classified according to the WHO classification. The primary endpoint was the proportion of OASIS. Results3552 patients were included: 2496 spontaneous deliveries (SD) and 1056 OVD (29.72 %). There were twenty sphincter tears (0.56 %): 7 in SD group (0.28 %) and 13 in OVD (1.23 %), P<0.0001, OR=5.10 [2.00; 12.99]. Other risk factors associated with OASIS in univariable analysis were: maternal age (≥30 years), duration of expulsive efforts (≥20min) and a birth weight≥4000g. ConclusionIn these patients, the risk of OASIS in case of AI increases by a factor of 5;10. The high rate of AI in these patients exposes them to a real risk of OASIS. However, the proportion of OASIS in this group remains lower than those reported in the literature and is barely higher than the national overall rate, despite a very restrictive policy of the use of episiotomy.