title: Risk factors for severe perineal lacerations during childbirth.
abstract: BACKGROUND
  Severe perineal lacerations represent a significant complication of normal labor with a strong impact on quality of life.
  
  
  OBJECTIVE
  To identify factors that lead to the occurrence of severe perineal lacerations.
  
  
  METHODS
  We searched MEDLINE, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Google Scholar and reference lists from all included studies.
  
  
  METHODS
  We included prospective and retrospective observational studies.
  
  
  METHODS
  Predetermined data were collected and analyzed with the Mantel-Haenszel fixed-effects model or the DerSimonian-Laird random-effects model.
  
  
  RESULTS
  The meta-analysis included 22 studies (n=651,934). Women with severe perineal tears were more likely to have had heavier infants (mean difference 192.88 g [95% CI, 139.80-245.96 g]), an episiotomy (OR 3.82 [95% CI, 1.96-7.42]), or an operative vaginal delivery (OR 5.10 [95% CI, 3.33-7.83]). Epidural anesthesia (OR 1.95 [95% CI, 1.63-2.32]), labor induction (OR 1.08 [95% CI, 1.02-1.14]), and labor augmentation (OR 1.95 [95% CI, 1.56-2.44]) were also more common among women with perineal lacerations.
  
  
  CONCLUSIONS
  Various factors contribute to the occurrence of perineal lacerations. Future studies should consistently evaluate all examined parameters to determine their possible interrelation.
authors: First Department of Obstetrics and Gynecology, Athens University Medical School, Alexandra Hospital, Athens, Greece. Electronic address: pergialiotis@hotmail.com.
authors: Vasileios
authors: V
authors: Pergialiotis
authors: First Department of Obstetrics and Gynecology, Athens University Medical School, Alexandra Hospital, Athens, Greece.
authors: Dimitrios
authors: D
authors: Vlachos
authors: First Department of Obstetrics and Gynecology, Athens University Medical School, Alexandra Hospital, Athens, Greece.
authors: Athanasios
authors: A
authors: Protopapas
authors: First Department of Obstetrics and Gynecology, Athens University Medical School, Alexandra Hospital, Athens, Greece.
authors: Kaliopi
authors: K
authors: Pappa
authors: First Department of Obstetrics and Gynecology, Athens University Medical School, Alexandra Hospital, Athens, Greece.
authors: Georgios
authors: G
authors: Vlachos
mesh_terms: D001724:Birth Weight; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D004841:Episiotomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D022125:Lacerations / Q000209:etiology* / Q000473:pathology; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Episiotomy; Forceps; Perineal lacerations; Perineal tears