Related Experiment Video
Updated: Jun 20, 2026
Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse (POP) Quantification System
Published on: September 20, 2018
Risk factors associated with deep perineal wound dehiscence after second-degree perineal tears or episiotomy
Denise Golmann1,2, Josefin Hedström1, Elisabeth Epstein1,2
1Department of Obstetrics and Gynecology, Stockholm South General Hospital (Södersjukhuset), Stockholm, Sweden.
Insights
Episiotomy significantly increases the risk of deep perineal wound dehiscence after childbirth. However, intrapartum antibiotics appear protective, suggesting their use may reduce this complication in women undergoing episiotomy or experiencing second-degree tears.
Area of Science:
- Obstetrics and Gynecology
- Surgical Wound Complications
- Maternal Health
Background:
- Second-degree perineal tears and episiotomies are common postpartum events.
- These injuries can lead to wound dehiscence, infection, and pelvic floor dysfunction.
- Risk factors for deep wound dehiscence involving perineal muscles are not well understood.
Purpose of the Study:
- To identify risk factors for deep wound dehiscence in second-degree perineal tears and episiotomies.
- To evaluate the association between episiotomy and wound dehiscence.
- To assess the potential protective effect of antibiotic prophylaxis.
Main Methods:
- A single-center case-control study with a 1:2 ratio was conducted.
- 105 cases of deep wound dehiscence were compared to 210 controls without dehiscence.
- Multivariate logistic regression was used to identify independent risk factors.
Main Results:
- Episiotomy was significantly associated with an increased risk of deep wound dehiscence (aOR 4.40).
- Intrapartum antibiotic administration was associated with a reduced risk of wound dehiscence (aOR 0.21).
- Vaginal primiparity and longer second stage of labor were also noted in cases.
Conclusions:
- Episiotomy substantially increases the risk of deep perineal wound dehiscence.
- Intrapartum antibiotics demonstrated a protective effect against wound dehiscence.
- Findings support selective episiotomy and suggest antibiotic prophylaxis may be beneficial.
Introduction:
Second-degree perineal tears and episiotomies, involving the bulbocavernosus and/or superficial transverse perineal muscles, are common after vaginal birth and may lead to wound dehiscence, infection, and long-term pelvic floor dysfunction. Despite this, risk factors for deep wound dehiscence involving perineal musculature remain insufficiently studied. This study aimed to identify risk factors for wound dehiscence in second-degree tears and episiotomies to inform potential use of antibiotic prophylaxis.
Material And Methods:
A single-center case-control study (1:2 ratio) was conducted including 105 cases with 2nd degree perineal tears or episiotomies complicated by deep wound dehiscence, diagnosed within two weeks postpartum and 210 controls with second-degree tears or episiotomies without dehiscence. Exposure data were retrieved from medical records. Univariate analyses were performed on a priori selected exposure variables, using Mann-Whitney U and Fisher's exact tests. Variable selection used Lasso regression with leave-one-out cross-validation. Multivariate logistic regression generated adjusted odds ratios (aOR). Statistical significance was set at p < 0.05.
Results:
Women with wound dehiscence were more often vaginal primiparas (87% vs 69%, p < 0.001) and had higher rates of episiotomy (33% vs 7%, p < 0.001). Intrapartum antibiotics were administered less frequently among cases (7% vs 20%, p = 0.002). Cases had longer second stage of labor, more active pushing, and greater postpartum bleeding. After multivariate adjustment, only episiotomy (aOR 4.40, 95% CI 2.10-9.64) and intrapartum antibiotic administration (aOR 0.21, 95% CI 0.07-0.50) remained significantly associated with wound dehiscence.
Conclusions:
Episiotomy substantially increased the risk of deep perineal wound dehiscence compared with spontaneous second-degree perineal tears, while intrapartum antibiotics were protective. These findings support selective episiotomy use and suggest that antibiotic prophylaxis may reduce this risk in women with second-degree perineal tears or episiotomies.
Related Concept Videos
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:24Healing II: Complications
01:22Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus.
01:07Intestinal Obstruction II: Pathophysiology
01:26Muscles of the Pelvic Floor and Perineum
Perineal Layer
The perineum is a diamond-shaped area below the pelvic diaphragm, divided into an anterior urogenital triangle that contains the external genitals and a posterior anal triangle housing the anus. The urogenital...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin create...