Abstract | OBJECTIVE: To assess the risk of severe perineal lacerations (III and IV degrees) during vaginal deliveries in occiput posterior position. PATIENTS AND METHODS: 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. RESULTS: 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). DISCUSSION AND CONCLUSION: 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.
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Authors | C Salameh, F Canoui-Poitrine, M Cortet, A Lafon, R-C Rudigoz, C Huissoud |
Journal | Gynecologie, obstetrique & fertilite
(Gynecol Obstet Fertil)
Vol. 39
Issue 10
Pg. 545-8
(Oct 2011)
ISSN: 1769-6682 [Electronic] France |
Vernacular Title | Les présentations postérieures augmentent-elles le risque de déchirures périnéales sévères? |
PMID | 21873097
(Publication Type: English Abstract, Journal Article)
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Copyright | Copyright © 2011 Elsevier Masson SAS. All rights reserved. |
Topics |
- 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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