title: Incidence of and risk factors for perineal trauma: a prospective observational study.
abstract: BACKGROUND
  Our aim was to describe the range of perineal trauma in women with a singleton vaginal birth and estimate the effect of maternal and obstetric characteristics on the incidence of perineal tears.
  
  
  METHODS
  We conducted a prospective observational study on all women with a planned singleton vaginal delivery between May and September 2006 in one obstetric unit, three freestanding midwifery-led units and home settings in South East England. Data on maternal and obstetric characteristics were collected prospectively and analysed using univariable and multivariable logistic regression. The outcome measures were incidence of perineal trauma, type of perineal trauma and whether it was sutured or not.
  
  
  RESULTS
  The proportion of women with an intact perineum at delivery was 9.6% (125/1,302) in nulliparae, and 31.2% (453/1,452) in multiparae, with a higher incidence in the community (freestanding midwifery-led units and home settings). Multivariable analysis showed multiparity (OR 0.52; 95% CI: 0.30-0.90) was associated with reduced odds of obstetric anal sphincter injuries (OASIS), whilst forceps (OR 4.43; 95% CI: 2.02-9.71), longer duration of second stage of labour (OR 1.49; 95% CI: 1.13-1.98), and heavier birthweight (OR 1.001; 95% CI: 1.001-1.001), were associated with increased odds. Adjusted ORs for spontaneous perineal truama were: multiparity (OR 0.42; 95% CI: 0.32-0.56); hospital delivery (OR 1.48; 95% CI: 1.01-2.17); forceps delivery (OR 2.61; 95% CI: 1.22-5.56); longer duration of second stage labour (OR 1.45; 95% CI: 1.28-1.63); and heavier birthweight (OR 1.001; 95% CI: 1.000-1.001).
  
  
  CONCLUSIONS
  This large prospective study found no evidence for an association between many factors related to midwifery practice such as use of a birthing pool, digital perineal stretching in the second stage, hands off delivery technique, or maternal birth position with incidence of OASIS or spontaneous perineal trauma. We also found a low overall incidence of OASIS, and fewer second degree tears were sutured in the community than in the hospital settings. This study confirms previous findings of overall high incidence of perineal trauma following vaginal delivery, and a strong association between forceps delivery and perineal trauma.
authors.affiliation: Department Social Work and Public Health, Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, OX3 0FL, UK. lesleysmith@brookes.ac.uk
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Smith
authors.forename: Natalia
authors.initials: N
authors.lastname: Price
authors.forename: Vanessa
authors.initials: V
authors.lastname: Simonite
authors.forename: Ethel E
authors.initials: EE
authors.lastname: Burns
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D001724:Birth Weight / Q000502:physiology; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D004739:England / Q000453:epidemiology; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007748:Labor Stage, Second / Q000502:physiology; D022125:Lacerations / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D013537:Sutures / Q000706:statistics & numerical data*