[Does persistent occiput posterior position increase the risk of severe perineal laceration?].

To assess the risk of severe perineal lacerations (III and IV degrees) during vaginal deliveries in occiput posterior position.
We conducted a retrospective cohort study of 9097 vaginal deliveries in a teaching hospital's maternity between January 1st 2005 and December 31st 2008. Risk factors associated with tears of the 3rd or 4th degree were studied by a multivariate logistic regression.
Severe perineal lacerations occurred in 1.69% of cases (n=152) and did not significantly vary between 2005 and 2008. Parity was a protective factor (OR 0.42; P<0.001; IC(95%) 0.29-0.60) whereas instrumental extraction was associated with an increased risk: vacuum (OR 3.95; P<0.001, IC(95%) 2.23-7.00) and forceps (OR 3.55; P<0.001, IC(95%) 2.33-5.42). macrosomia. Risks were also increased in fetal macrosomia and episiotomy did not protect the mother (respectively OR 1.41 P<0.001, IC(95%) 1.19-1.68 and OR 1.73; P<0.001, IC(95%) 1.16-2.57). Persistent occiput posterior position was not significantly associated with an anal sphincter injury (OR=1.70 P=0.059; IC(95%) 0.98-2.94).
In our series, occiput posterior position did not significantly impact the risk of severe perineal laceration. A manual rotation of the fetal head should be performed in case of associated risk factors.
AuthorsC Salameh, F Canoui-Poitrine, M Cortet, A Lafon, R-C Rudigoz, C Huissoud
JournalGynécologie, obstétrique & fertilité (Gynecol Obstet Fertil) Vol. 39 Issue 10 Pg. 545-8 (Oct 2011) ISSN: 1769-6682 [Electronic] France
Vernacular TitleLes présentations postérieures augmentent-elles le risque de déchirures périnéales sévères?
PMID21873097 (Publication Type: English Abstract, Journal Article)
CopyrightCopyright © 2011 Elsevier Masson SAS. All rights reserved.
  • Adult
  • Episiotomy
  • Extraction, Obstetrical
  • Female
  • Fetal Macrosomia (complications)
  • Humans
  • Labor Presentation
  • Lacerations (etiology)
  • Parity
  • Perineum (injuries)
  • Pregnancy
  • Pregnancy Complications (etiology)
  • Retrospective Studies
  • Risk
  • Severity of Illness Index
  • Version, Fetal (adverse effects, methods)

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