Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study.
BMC Pregnancy Childbirth
; 17(1): 72, 2017 Feb 21.
Article
em En
| MEDLINE
| ID: mdl-28222704
ABSTRACT
BACKGROUND:
We sought to investigate the impact of the duration of second stage of labor on risk of severe perineal lacerations (third and fourth degree).METHODS:
This population based cohort study was conducted in the Stockholm/Gotland region, Sweden, 2008-2014. Study population included 52 211 primiparous women undergoing vaginal delivery with cephalic presentation at term. Unconditional logistic regression analysis was used to calculate crude and adjusted odds ratios (OR), using 95% confidence intervals (CI). Main exposure was duration of second stage of labor, and main outcome was risks of severe perineal lacerations (third and fourth degree).RESULTS:
Risk of severe perineal lacerations increased with duration of second stage of labor. Compared with a second stage of labor of 1 h or less, women with a second stage of more than 2 h had an increased risk (aOR 1.42; 95% CI 1.28-1.58). Compared with non-instrumental vaginal deliveries, the risk was elevated among instrumental vaginal deliveries (aOR 2.24; 95% CI 2.07-2.42). The risk of perineal laceration increased with duration of second stage of labor until less than 3 h in both instrumental and non-instrumental vaginal deliveries, but after 3 h, the ORs did not further increase. After adjustments for potential confounders, macrosomia (birth weight > 4 500 g) and occiput posterior fetal position were risk factors of severe perineal lacerations.CONCLUSIONS:
The risk of severe perineal laceration increases with duration until the third hour of second stage of labor. Instrumental delivery is the most significant risk factor for severe lacerations, followed by duration of second stage of labor, fetal size and occiput posterior fetal position.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Períneo
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Vigilância da População
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Lacerações
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Parto Obstétrico
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Episiotomia
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Complicações do Trabalho de Parto
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Forceps Obstétrico
Tipo de estudo:
Etiology_studies
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Observational_studies
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Risk_factors_studies
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Screening_studies
Limite:
Adult
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Female
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Humans
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Male
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Newborn
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Pregnancy
País como assunto:
Europa
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article