title: Factors associated with anal sphincter laceration in 40,923 primiparous women.
abstract: The objective of this study was to identify factors associated with anal sphincter laceration in primiparous women. A subpopulation of 40,923 primiparous women at term with complete data sets was abstracted from a state-wide perinatal database in Germany. Outcome variable was anal sphincter laceration. Independent variables were 17 known obstetrical risk factors/conditions/interventions impacting childbirth recorded on the perinatal data collection sheet. Cross table analysis followed by logistic regression analysis was used for data analysis. Logistic regression showed episiotomy (OR, 3.23; CI, 2.73-3.80) and forceps delivery (OR, 2.68, CI, 2.17-3.33) to be most strongly associated with anal sphincter laceration. Women with a BMI >or= 30 kg/m2, and smokers had a significantly lower risk of anal sphincter laceration. Local, pudendal, and epidural analgesia all reduced the risk of anal sphincter laceration. Iatrogenic factors most strongly associated with anal sphincter laceration in primiparous women include routine episiotomy and forceps delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Hutzel Women's Hospital-Detroit Medical Center, Wayne State University, 3990 John R., 7 Brush North, #166, Detroit, MI 48201, USA. pbaumann@med.wayne.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Baumann
authors.forename: Ahmad O
authors.initials: AO
authors.lastname: Hammoud
authors.forename: Samuel Gene
authors.initials: SG
authors.lastname: McNeeley
authors.forename: Elizabeth
authors.initials: E
authors.lastname: DeRose
authors.forename: Bela
authors.initials: B
authors.lastname: Kudish
authors.forename: Susan
authors.initials: S
authors.lastname: Hendrix
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D019992:Databases as Topic; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D004841:Episiotomy / Q000009:adverse effects; D005260:Female; D005858:Germany; D006801:Humans; D022125:Lacerations / Q000209:etiology*; D016015:Logistic Models; D009772:Obstetrical Forceps / Q000009:adverse effects; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors