Association of spontaneous perineal stretching during delivery with perineal lacerations.
OBJECTIVE
To evaluate the effect of perineal stretching on perineal damage during vaginal delivery.


METHODS
Patients at term in active labor were included. Perineal length was measured during the active phase, second stage and 24 hours postpartum. Perineal damage was assessed before repair and 24 hours postpartum.


RESULTS
Three hundred women were included. Mean perineal length during the active phase was 4.02 +/- 1.07 cm, and mean stretching was 2.25 +/- 1.2 cm. Of the parturients who had stretched the perineum > 150%, 40.7% required perineal repair as compared with 19.5% of parturients with less perineal stretching (p < 0.005). Significant risk factors included: age and parity, ethnicity, use of epidural, second-stage length, and perineal stretching. Stretching of > 150% remained significant in a multivariate mode (OR 2.11, p < 0.01).


CONCLUSIONS
Second-stage perineal stretching > 150% was predictive of perineal damage. In trying to avoid unnecessary episiotomies, this method may prove helpful.
Walfisch
Asnat
A
Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
Hallak
Mordechai
M
Harlev
Shlomit
S
Mazor
Moshe
M
Shoham-Vardi
Ilana
I
D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004841:Episiotomy; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D022125:Lacerations / Q000209:etiology*; D007744:Obstetric Labor Complications / Q000209:etiology; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012307:Risk Factors