title: Risk factors for the breakdown of perineal laceration repair after vaginal delivery.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Meredith K
authors.initials: MK
authors.lastname: Williams
authors.forename: Mark C
authors.initials: MC
authors.lastname: Chames
mesh_terms: 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
chemical_list: D011098:Polyglactin 910