title: Racial differences in severe perineal lacerations after vaginal delivery.
abstract: OBJECTIVE
  The purpose of this study was to determine the relationship between maternal race and rates of third- and fourth-degree laceration after vaginal delivery.
  
  
  METHODS
  An electronic audit of the medical procedures database at Thomas Jefferson University Hospital from 1983 through 2000 was completed. Univariate and multivariable models were computed with the use of logistic regression models.
  
  
  RESULTS
  From the database, 34,048 vaginal deliveries were identified, with 3487 deliveries resulting in third- or fourth-degree laceration (10.2%). Overall severe laceration rates by race with all vaginal deliveries for patients without and with episiotomy were as follows: white, 4.3% and 15.1%; black, 2.0% and 19.3%; Asian 9.1% and 32.3%; Hispanic, 3.4% and 17.0%, respectively. After being controled for other variables with multivariable logistic regression in all vaginal deliveries, Asian race (odds ratio, 2.04; 95% CI, 1.43-2.92), forceps (odds ratio, 3.71; 95% CI, 3.39-4.05), vacuum-assisted delivery (odds ratio, 1.86; 95% CI, 1.64-2.10), large size for gestational age (odds ratio, 1.94; 95% CI, 1.21-3.09), and episiotomy (odds ratio, 3.09; 95% CI, 2.66-3.59) were associated significantly with severe lacerations.
  
  
  CONCLUSIONS
  Race is an independent risk factor for severe perineal lacerations after vaginal delivery, with Asian women at highest risk. Asian women who undergo episiotomy and operative vaginal delivery are especially at high risk for rectal sphincter injury.
authors.affiliation: Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA. jay.goldberg@mail.tju.edu
authors.forename: Jay
authors.initials: J
authors.lastname: Goldberg
authors.forename: Terry
authors.initials: T
authors.lastname: Hyslop
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Tolosa
authors.forename: Carmen
authors.initials: C
authors.lastname: Sultana
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D022125:Lacerations / Q000453:epidemiology*; D015999:Multivariate Analysis; D010414:Pennsylvania / Q000453:epidemiology; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D015599:Trauma Severity Indices; D044465:White People / Q000706:statistics & numerical data*