RESUMEN
OBJECTIVE: Obstetric anal sphincter injuries are feared perineal injuries that are associated with increased pelvic floor disorders. The knowledge of influencing factors as the mode of delivery is therefore important. The aim of this study is to compare the rate of obstetric anal sphincter injuries in primiparae after water and bed deliveries. STUDY DESIGN: In this retrospective cohort study 3907 primiparae gave birth in water or on a bed in a Swiss teaching hospital. The diagnosis of obstetric anal sphincter injuries was confirmed by a consultant of obstetrics and gynecology and treated by them. The rates of these injuries after water and bed births were compared. Subgroup analysis was performed to detect possible associative factors, such as birth weight, episiotomy, use of oxytocin in first and second stage of labor. RESULTS: 1844 (47.2 %) of the primiparae had a water delivery and 2063 (52.8 %) a bed delivery. 193 (4.94 %) were diagnosed with obstetric anal sphincter injuries, of which 68 (3.7 %) had a water delivery and 125 (6.1 %) a bed delivery, p < 0.001. Subgroup analysis revealed that, in the first and second stage of labor, the rate of obstetric anal sphincter injuries with oxytocin was significantly lower in water than in bed deliveries; p = 0.025, p < 0.017, respectively. The rate of obstetric anal sphincter injuries in the birth weight or episiotomy subgroups did not reach significance. CONCLUSIONS: In a teaching hospital setting with standardized labor management, primiparae with a water delivery have the lowest risk for obstetric anal sphincter injuries.
Asunto(s)
Laceraciones , Complicaciones del Trabajo de Parto , Embarazo , Femenino , Humanos , Parto Obstétrico/efectos adversos , Estudios Retrospectivos , Oxitocina/uso terapéutico , Canal Anal/lesiones , Peso al Nacer , Suiza/epidemiología , Factores de Riesgo , Episiotomía , Hospitales Públicos , Hospitales de Enseñanza , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones del Trabajo de Parto/prevención & control , Laceraciones/epidemiología , Laceraciones/etiología , Laceraciones/prevención & controlRESUMEN
In today's modern obstetrics, perinatal morbidity and mortality of mother and neonate have become extremely rare. Despite these advances, are pregnant women still afraid of childbearing and, if so, what--and how intense--are their fears? Are these fears influenced by previous birthing experiences and by birth preparation classes? Data from more than 8000 expectant mothers (collated via a prenatal questionnaire distributed between November 1, 1991 and October 31, 1999) are evaluated. This study examines and discusses the answers concerning quantity and quality of childbirth-related fear among women of differing parity and its possible relation to attended birth preparation classes. The women delivered in a hospital setting that practices modern obstetrics combined with alternative delivery methods. The most frequent fears mentioned are fear for the child's health (50%) and fear of pain (40%). Fears dealing with medical intervention, such as operative delivery, anesthesia, nerve blockage and of being at the mercy of obstetrics all lie at around 12%. It is difficult to establish a clear-cut benefit of birth preparation classes in reducing childbirth fears.