title: Characteristics associated with severe perineal and cervical lacerations during vaginal delivery.
abstract: OBJECTIVE
  To characterize potentially modifiable risk factors for third- or fourth-degree perineal lacerations and cervical lacerations in a contemporary U.S. obstetric practice.
  
  
  METHODS
  The Consortium on Safe Labor collected electronic medical records from 19 hospitals within 12 institutions (228,668 deliveries from 2002 to 2008). Information on patient characteristics, prenatal complications, labor and delivery data, and maternal and neonatal outcomes were collected. Only women with successful vaginal deliveries of cephalic singletons at 34 weeks of gestation or later were included; we excluded data from sites lacking information about lacerations at delivery and deliveries complicated by shoulder dystocia; 87,267 and 71,170 women were analyzed for third- or fourth-degree and cervical lacerations, respectively. Multivariable logistic regressions were used to adjust for other factors.
  
  
  RESULTS
  Third- or fourth-degree lacerations occurred in 2,516 women (2,223 nulliparous [5.8%], 293 [0.6%] multiparous) and cervical lacerations occurred in 536 women (324 nulliparous [1.1%], 212 multiparous [0.5%]). Risks for third- or fourth-degree lacerations included nulliparity (7.2-fold risk), being Asian or Pacific Islander, increasing birth weight, operative vaginal delivery, episiotomy, and longer second stage of labor. Increasing body mass index was associated with fewer lacerations. Risk factors for cervical lacerations included young maternal age, vacuum vaginal delivery, and oxytocin use among multiparous women, and cerclage regardless of parity.
  
  
  CONCLUSIONS
  Our large cohort of women with severe obstetric lacerations reflects contemporary obstetric practices. Nulliparity and episiotomy use are important risk factors for third- or fourth-degree lacerations. Cerclage increases the risk for cervical lacerations. Many identified risk factors may not be modifiable.
authors.affiliation: From the Georgetown University Hospital, MedStar Health, Washington, DC; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio; Indiana University Clarian Health, Indianapolis, Indiana; University of Miami, Miami, Florida; University of Texas Health Science Center at Houston, Houston, Texas; Maimonides Medical Center, Brooklyn, New York; University of Illinois at Chicago, Chicago, Illinois; Intermountain Healthcare and the University of Utah, Salt Lake City, Utah; Tufts University, Baystate Medical Center, Springfield, Massachusetts; Cedars-Sinai Medical Center, Los Angeles, California; Christiana Care Health System, Newark, Delaware; Summa Health Systems, Akron City Hospital, Akron, Ohio; and the EMMES Corporation, Rockville, Maryland.
authors.forename: Helain J
authors.initials: HJ
authors.lastname: Landy
authors.forename: S Katherine
authors.initials: SK
authors.lastname: Laughon
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bailit
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Kominiarek
authors.forename: Victor Hugo
authors.initials: VH
authors.lastname: Gonzalez-Quintero
authors.forename: Mildred
authors.initials: M
authors.lastname: Ramirez
authors.forename: Shoshana
authors.initials: S
authors.lastname: Haberman
authors.forename: Judith
authors.initials: J
authors.lastname: Hibbard
authors.forename: Isabelle
authors.initials: I
authors.lastname: Wilkins
authors.forename: D Ware
authors.initials: DW
authors.lastname: Branch
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Burkman
authors.forename: Kimberly
authors.initials: K
authors.lastname: Gregory
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Hoffman
authors.forename: Lee A
authors.initials: LA
authors.lastname: Learman
authors.forename: Christos
authors.initials: C
authors.lastname: Hatjis
authors.forename: Paul C
authors.initials: PC
authors.lastname: VanVeldhuisen
authors.forename: Uma M
authors.initials: UM
authors.lastname: Reddy
authors.forename: James
authors.initials: J
authors.lastname: Troendle
authors.forename: Liping
authors.initials: L
authors.lastname: Sun
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000009:adverse effects; D002584:Cervix Uteri / Q000293:injuries*; D004841:Episiotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000208:ethnology / Q000209:etiology*; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult