Risk factors for the breakdown of perineal laceration repair after vaginal delivery.
OBJECTIVE
The purpose of this study was to identify risk factors that are associated with the breakdown of perineal laceration repair in the postpartum period.


METHODS
We conducted a retrospective, case-control study to review perineal laceration repair breakdown in patients who were delivered between September 1995 and February 2005 at the University of Michigan. Bivariate analysis with chi-square test and t-test and stepwise logistic regression analysis were performed.


RESULTS
Fifty-nine cases and 118 control deliveries were identified from a total of 14,124 vaginal deliveries. Risk factors were longer second stage of labor (142 vs 87 minutes; P = .001), operative vaginal delivery (odds ratio, 3.6; 95% CI, 1.8-7.3), mediolateral episiotomy (odds ratio, 6.9; 95% CI, 2.6-18.7), third- or fourth-degree laceration (odds ratio, 3.1; 95% CI, 1.5-6.4), and meconium-stained amniotic fluid (odds ratio, 3.0; 95% CI, 1.1-7.9). Previous vaginal delivery was protective (odds ratio, 0.38; 95% CI, 0.18-0.84). Logistic regression showed the most significant factor to be an interaction between operative vaginal delivery and mediolateral episiotomy (odd ratio, 6.36; 95% CI, 2.18-18.57).


CONCLUSIONS
The most significant events were mediolateral episiotomy, especially in conjunction with operative vaginal delivery, third- and fourth-degree lacerations, and meconium.
Williams
Meredith K
MK
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Chames
Mark C
MC
D000328:Adult; D016022:Case-Control Studies; D004841:Episiotomy / Q000009:adverse effects; D005113:Extraction, Obstetrical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000601:surgery*; D016015:Logistic Models; D010502:Perineum / Q000293:injuries*; D011098:Polyglactin 910; D049590:Postpartum Period; D011247:Pregnancy; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000209:etiology; D013537:Sutures
D011098:Polyglactin 910