title: Breakdown of Perineal Laceration Repair After Vaginal Delivery: A Case-Control Study.
abstract: The aim of the study was to estimate risk factors associated with breakdown of perineal laceration repair after vaginal delivery.
  
  
  
  This is a case-control study of women who sustained a breakdown of perineal laceration repair after vaginal delivery between 2002 and 2015. Cases were patients who sustained a perineal wound breakdown after vaginal delivery and repair of a second-, third-, or fourth-degree laceration. Controls, matched 1:1, were patients who either sustained a second-, third-, or fourth-degree perineal laceration and repair without evidence of breakdown and who delivered on the same day and institution as the case.
  
  
  
  A total of 104,301 deliveries were assessed for breakdown of perineal laceration. One hundred forty-four met the inclusion criteria. These were matched with 144 controls. Logistic regression analysis demonstrated that smoking is associated with increased risk for breakdown of perineal laceration (adjusted odds ratio [adj. OR], 6.4; 95% confidence interval [CI], 1.2-38.5), whereas a previous vaginal delivery is protective (adj. OR, 0.14; 95% CI, 0.05-0.3). In addition, third- or fourth-degree laceration (adj. OR, 4.0; 95% CI, 1.1-15.7), presence of episiotomy at time of delivery (adj. OR, 11.1; 95% CI, 2.9-48.8), operative delivery (adj. OR, 3.4; 95% CI, 1.2-10.3), midwife performing the laceration repair (adj. OR, 4.7; 95% CI, 1.5-15.8), and use of chromic suture (adj. OR, 3.9; 95% CI, 1.6-9.8) were independent risk factors for breakdown of perineal laceration.
  
  
  
  Smoking, nulliparity, episiotomy, operative delivery, third- or fourth-degree laceration, repair by a midwife, and use of chromic suture are independent risk factors for breakdown of perineal laceration repair after vaginal delivery.
authors.affiliation: From the Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Karl
authors.initials: K
authors.lastname: Jallad
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Steele
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000145:classification / Q000601:surgery*; D008880:Midwifery; D007744:Obstetric Labor Complications / Q000503:physiopathology; D010298:Parity; D010502:Perineum / Q000293:injuries* / Q000601:surgery; D011247:Pregnancy; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors