title: Risk factors for severe perineal injury during childbirth: a case-control study of 60 consecutive cases.
abstract: OBJECTIVE
  The study aimed to evaluate the current risk factors for severe perineal tears in a single university-affiliated maternity hospital.
  
  
  METHODS
  An obstetric database of 31 784 consecutive women who delivered from January 2007 to December 2009 was screened for cases of third-degree or fourth-degree perineal tears. Four controls, matched by time of delivery, were selected for each case of third- or fourth-degree perineal tear. Maternal and obstetric parameters were analyzed and compared between the study and control groups.
  
  
  RESULTS
  Sixty women (0.25% of all vaginal deliveries) had a third-degree (53 women) or a fourth-degree (seven women) perineal tear. The control group comprised 240 matched vaginal deliveries without severe tears. Primiparity, younger maternal age, Asian ethnicity, longer duration of second stage of labour, vacuum-assisted delivery and heavier newborn birth weight were significantly more common among women who had third- or fourth-degree perineal tears. Of the variables that were found to be statistically significant in the univariate analysis, only primiparity (OR = 2.809, 95% CI: 1.336-5.905), vacuum delivery (OR = 10.104, 95% CI: 3.542-28.827) and heavier newborn birth weight (OR = 1.002, 95% CI: 1.001-1.003) were found to be statistically significant independent risk factors for severe perineal trauma.
  
  
  CONCLUSIONS
  Identification of women at risk may facilitate the use, or avoidance, of certain obstetric interventions to minimize the occurrence of childbirth-associated perineal trauma.
authors.affiliation: Urogynaecology and Pelvic Floor Unit, Department of Obstetrics and Gynaecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Israel. agroutz@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Groutz
authors.forename: A
authors.initials: A
authors.lastname: Cohen
authors.forename: R
authors.initials: R
authors.lastname: Gold
authors.forename: J
authors.initials: J
authors.lastname: Hasson
authors.forename: A
authors.initials: A
authors.lastname: Wengier
authors.forename: J B
authors.initials: JB
authors.lastname: Lessing
authors.forename: D
authors.initials: D
authors.lastname: Gordon
mesh_terms: D000328:Adult; D044466:Asian People; D001724:Birth Weight; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D022125:Lacerations / Q000208:ethnology / Q000209:etiology*; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000208:ethnology; D010298:Parity; D036801:Parturition; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*; D055815:Young Adult