Length of the second stage of labor as a predictor of perineal outcome after vaginal delivery.
OBJECTIVE
To evaluate possible risk factors for spontaneous and induced perineal damage during vaginal delivery.


METHODS
A prospective, observational study was conducted with 300 patients at 37-42 weeks of singleton gestation who presented in active labor. Sociodemographic data, birth circumstances and past medical history were obtained upon admission. Perineal damage was assessed before repair and 24 hours postpartum. A multiple logistic regression model was constructed to investigate independent risk factors for spontaneous perineal lacerations.


RESULTS
Of 300 women included, 139 were primiparas. Episiotomy was performed in 32% of the population (62% in primiparas, 6% in multiparas). Spontaneous perineal tears requiring suturing occurred in 28%. Severe perineal tears (grades 3 and 4) occurred in 1%. Risk factors for adverse perineal outcome in the nonepisiotomy group included younger maternal age, non-Israeli ethnic background, use of epidural analgesia, nulliparity, shorter interval since last vaginal delivery, longer active phase and prolonged second stage. Prolonged second stage (> 40 minutes) and low parity were independent risk factors for perineal tears in a multivariable analysis.


CONCLUSIONS
Identifying women in specific subgroups at high risk for perineal lacerations may minimize perineal damage. Women with a prolonged second stage of labor and low parity are prone for spontaneous damage and therefore deserve special attention.
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel. sheiner@bgumail.bgu.ac.il
Eyal
E
Sheiner
Asnat
A
Walfisch
Mordechai
M
Hallak
Shlomit
S
Harlev
Moshe
M
Mazor
Ilana
I
Shoham-Vardi
D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D004841:Episiotomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007748:Labor Stage, Second; D022125:Lacerations / Q000209:etiology* / Q000517:prevention & control; D016015:Logistic Models; D008423:Maternal Age; D015999:Multivariate Analysis; D009321:Natural Childbirth / Q000009:adverse effects / Q000379:methods; D007744:Obstetric Labor Complications / Q000209:etiology* / Q000503:physiopathology; D010298:Parity; D010502:Perineum / Q000293:injuries*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors