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Published on: September 20, 2018
Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium
Asnat Groutz1, Joseph Hasson, Anat Wengier
1Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. agroutz@yahoo.com
Objective:
We sought to assess the modern prevalence and risk factors for third- and fourth-degree perineal tears.
Study Design:
The study population comprised 38,252 women who delivered in one medical center, from January 2005 through December 2009, and met the following inclusion criteria: singleton pregnancy, vertex presentation, and vaginal delivery. Of these, 96 women (0.25%) sustained third- or fourth-degree perineal tears. Maternal and obstetric variables were compared between women with vs without severe perineal tears.
Results:
Five variables were found to be statistically significant independent risk factors: Asian ethnicity (odds ratio [OR], 8.9; 95% confidence interval [CI], 4.2-18.9), primiparity (OR, 2.4; 95% CI, 1.5-3.7), persistent occipito posterior (OR, 2.1; 95% CI, 1-4.5), vacuum delivery (OR, 2.7; 95% CI, 1.6-4.6), and heavier birthweight (OR, 1.001; 95% CI, 1-1.001).
Conclusion:
Severe perineal tears are uncommon in modern obstetric practice. Significant risk factors are Asian ethnicity, primiparity, persistent occipito posterior, vacuum delivery, and heavier birthweight.
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