Labour curve findings associated with fourth degree sphincter disruption: the impact of labour progression on perineal trauma.
OBJECTIVE
To compare the labour curves of primigravid women with fourth degree perineal laceration with those of control subjects, and to identify characteristics of the labour curve that are associated with anal sphincter disruption.


METHODS
In this retrospective case-control study we constructed labour curves describing the mean cervical dilation and head descent for 72 primigravidas with fourth degree laceration and compared these with the labour curves of 72 consecutive primigravidas having a vaginal delivery without sphincter laceration.


RESULTS
The control cervical dilatation curve resembled the Friedman labour curve, consisting of an acceleration phase, a phase of maximal slope, and a deceleration phase. In contrast, the dilatation curve of the laceration group was longer and had an increasing rate of dilatation without a deceleration phase. While the rate of head descent progressively decreased in the control group, it accelerated in the laceration group.


CONCLUSIONS
Labour curves for the sphincter laceration and control groups were different. Increasing rates of cervical dilatation and head descent were associated with fourth degree perineal laceration.
Nguyen
Thao
T
Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore MD.
Handa
Victoria L
VL
Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore MD.
Hueppchen
Nancy
N
Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore MD.
Cundiff
Geoffrey W
GW
Department of Obstetrics and Gynaecology, University of British Columbia School of Medicine, Vancouver BC.
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D001724:Birth Weight; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007747:Labor Stage, First / Q000502:physiology; D007751:Labor, Induced / Q000706:statistics & numerical data; D007743:Labor, Obstetric / Q000502:physiology*; D008875:Middle Aged; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors