title: Association of spontaneous perineal stretching during delivery with perineal lacerations.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Asnat
authors.initials: A
authors.lastname: Walfisch
authors.forename: Mordechai
authors.initials: M
authors.lastname: Hallak
authors.forename: Shlomit
authors.initials: S
authors.lastname: Harlev
authors.forename: Moshe
authors.initials: M
authors.lastname: Mazor
authors.forename: Ilana
authors.initials: I
authors.lastname: Shoham-Vardi
mesh_terms: 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