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Related Experiment Videos

Risk factors for third degree perineal ruptures during delivery.

J W de Leeuw1, P C Struijk, M E Vierhout

  • 1Department of Obstetrics and Gynaecology, Ikazia Hospital, The Netherlands.

BJOG : an International Journal of Obstetrics and Gynaecology
|April 18, 2001
PubMed
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Hands up if you do not understand hands on.

Midwifery·2020

Mediolateral episiotomy significantly reduces third-degree perineal tears during vaginal delivery, preventing anal sphincter damage. Forceps delivery poses a higher risk than vacuum extraction for these severe tears.

Area of Science:

  • Obstetrics and Gynecology
  • Perinatology
  • Surgical Safety

Background:

  • Third-degree perineal tears, involving anal sphincter damage, are a significant complication of vaginal delivery.
  • Risk factors and preventative measures for severe perineal trauma require further investigation to improve maternal outcomes.

Purpose of the Study:

  • To identify risk factors associated with third-degree perineal tears during vaginal delivery.
  • To evaluate the protective effect of mediolateral episiotomy and compare risks of assisted vaginal delivery instruments.

Main Methods:

  • A population-based observational study analyzed 284,783 vaginal deliveries from the Dutch National Obstetric Database (1994-1995).
  • Logistic regression was employed to determine risk factors for third-degree perineal ruptures, defined as anal sphincter involvement.

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Main Results:

  • High fetal birth weight, prolonged second stage of labor, and primiparity were linked to increased risk of anal sphincter damage.
  • Mediolateral episiotomy demonstrated strong protective effects (OR: 0.21), while forceps delivery significantly increased risk (OR: 3.33) compared to vacuum extraction.
  • All assisted vaginal deliveries elevated the risk of third-degree tears, with combined instrument use further increasing risk.

Conclusions:

  • Mediolateral episiotomy is a highly effective preventive measure against third-degree perineal ruptures and subsequent fecal incontinence.
  • Forceps delivery presents a greater risk for severe perineal tears than vacuum extraction; vacuum extraction is preferred when feasible to minimize anal sphincter injury.