Demographic variations and clinical associations of episiotomy and severe perineal lacerations in vaginal delivery.
Primiparity, birthweight, operative delivery and obstetrical complications contribute to episiotomy and severe perineal lacerations. Episiotomy correlates with Hispanics, while African Americans correlate with severe perineal lacerations.


OBJECTIVE
The purpose of this study was to identify risk factors for both episiotomy and severe perineal lacerations in a large population from a single institution.


METHODS
This was a review of 66,224 vaginal deliveries of African Americans or Hispanics delivering between 25-44 gestational weeks between 1981-2001. Univariate and multiple regression analysis were done as indicated.


RESULTS
Independent predictors of episiotomy were: primiparity eight-fold, forceps delivery seven-fold, vacuum delivery five-fold, shoulder dystocia 3.6-fold, macrosomia 1.8-fold, epidural analgesia 1.6-fold, postdates 1.5-fold, Hispanics 1.4-fold. Independent predictors of severe perineal lacerations were; macrosomia seven-fold, episiotomy 4.5-fold, primiparity 4.4-fold, shoulder dystocia 3.6-fold, average birthweight 3.5-fold, forceps delivery 2.6-fold, vacuum delivery two-fold, epidural analgesia two-fold, African-American 1.5-fold. Nonreassuring fetal heart rate patterns, meconium and cord accidents appeared protective.


CONCLUSIONS
Primiparous women with larger babies undergoing operative delivery with epidural analgesia are at risk for both episiotomy incisions and severe perineal lacerations. Though Hispanics are more likely to have an episiotomy, they are at significantly less risk for severe perineal lacerations compared to African Americans. Even though episiotomy is independently associated with severe perineal laceration, other factors such as macrosomia and primiparity are as important.
Ogunyemi
Dotun
D
Department of Obstetrics & Gynecology, Charles R. Drew University of Medicine & Science/UCLA, Los Angeles, CA, USA. ogunyemid@cshs.org
Manigat
Brandy
B
Marquis
Jesse
J
Bazargan
Mohsen
M
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D001724:Birth Weight; D036861:Delivery, Obstetric / Q000009:adverse effects; D004841:Episiotomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000209:etiology*; D016015:Logistic Models; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D012307:Risk Factors