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Risk factors for perineal trauma in the primiparous population during non-operative vaginal delivery

Risk factors for perineal trauma in the primiparous population during non-operative vaginal delivery
Risk factors for perineal trauma in the primiparous population during non-operative vaginal delivery
Introduction and hypothesis

Obstetric anal sphincter injuries (OASIS) are more common in the primiparous population, especially during operative vaginal delivery (OVD). It would therefore be interesting to establish what factors influence the risk of OASIS when adjusting for the risk bias of OVD.

Methods

Retrospective analysis of prospectively collected data from the maternity database at University of Southampton NHS Foundation Trust of primiparous women sustaining OASIS during a singleton, term, cephalic, non-operative vaginal delivery between 2004 and 2015. A control comparison was made of women with otherwise identical birthing conditions but resulting with intact perinea, delivering between 2014 and 2015. Univariate and multivariate logistic regression compared maternal, intrapartum and neonatal factors of those sustaining OASIS with those with an intact perineum.

Results

Seven hundred fifty-six women sustaining an OASI met the criteria, and comparisons were made with a control population of 212. Those sustaining an OASI were significantly older (p < 0.001), more likely to be Asian (4.6-fold, p < 0.001) and had heavier babies, with a 3.6-fold greater proportion over 4 kg (p = 0.001). They were more likely to have delivered post-term and had longer second stages of labour (both p < 0.001). Epidural anaesthesia was associated with a 67% reduction in OASIS.

ConclusionsThese findings support previous research regarding risk factors for OASIS. By controlling for bias of risk associated with operative vaginal delivery, this revealed a potential protective effect of the use of regional anaesthesia.
Obstetric anal sphincter injuries (OASIS), Obstetric anal sphincter injury (OASI), Perineal trauma, Primiparity
0937-3462
1-5
D’Souza, Joanna C.
714419e4-b3a9-42cf-9838-913b880ced88
Monga, Ash
60b415bd-97b3-485b-b641-0751151036d3
Tincello, Douglas G.
6dcd9583-06ff-46f0-8e2c-c1fc338734d9
D’Souza, Joanna C.
714419e4-b3a9-42cf-9838-913b880ced88
Monga, Ash
60b415bd-97b3-485b-b641-0751151036d3
Tincello, Douglas G.
6dcd9583-06ff-46f0-8e2c-c1fc338734d9

D’Souza, Joanna C., Monga, Ash and Tincello, Douglas G. (2019) Risk factors for perineal trauma in the primiparous population during non-operative vaginal delivery. International Urogynecology Journal, 1-5. (doi:10.1007/s00192-019-03944-7).

Record type: Article

Abstract

Introduction and hypothesis

Obstetric anal sphincter injuries (OASIS) are more common in the primiparous population, especially during operative vaginal delivery (OVD). It would therefore be interesting to establish what factors influence the risk of OASIS when adjusting for the risk bias of OVD.

Methods

Retrospective analysis of prospectively collected data from the maternity database at University of Southampton NHS Foundation Trust of primiparous women sustaining OASIS during a singleton, term, cephalic, non-operative vaginal delivery between 2004 and 2015. A control comparison was made of women with otherwise identical birthing conditions but resulting with intact perinea, delivering between 2014 and 2015. Univariate and multivariate logistic regression compared maternal, intrapartum and neonatal factors of those sustaining OASIS with those with an intact perineum.

Results

Seven hundred fifty-six women sustaining an OASI met the criteria, and comparisons were made with a control population of 212. Those sustaining an OASI were significantly older (p < 0.001), more likely to be Asian (4.6-fold, p < 0.001) and had heavier babies, with a 3.6-fold greater proportion over 4 kg (p = 0.001). They were more likely to have delivered post-term and had longer second stages of labour (both p < 0.001). Epidural anaesthesia was associated with a 67% reduction in OASIS.

ConclusionsThese findings support previous research regarding risk factors for OASIS. By controlling for bias of risk associated with operative vaginal delivery, this revealed a potential protective effect of the use of regional anaesthesia.

Text
DSouza 2019 Article Risk Factors For Perineal Trauma - Version of Record
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More information

Accepted/In Press date: 28 March 2019
e-pub ahead of print date: 2 May 2019
Keywords: Obstetric anal sphincter injuries (OASIS), Obstetric anal sphincter injury (OASI), Perineal trauma, Primiparity

Identifiers

Local EPrints ID: 431269
URI: http://eprints.soton.ac.uk/id/eprint/431269
ISSN: 0937-3462
PURE UUID: 4dce406a-a823-40bd-98ce-d316a5c21d23

Catalogue record

Date deposited: 29 May 2019 16:30
Last modified: 16 Mar 2024 02:04

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Contributors

Author: Joanna C. D’Souza
Author: Ash Monga
Author: Douglas G. Tincello

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