Original Article

Severe obstetric tears: a prospective observational study in an Italian referral unit

  • STEFANIA LIVIO
  • MARCO SOLIGO
  • ELENA DE PONTI
  • ILEANA SCEBBA
  • FEDERICA CARPENTIERI
  • ENRICO M. FERRAZZI

Pelviperineology 2016;35(2):40-43

Vaginal birth can be accompanied by pelvic complications: vaginal tears, cervical and perineal lacerations, which are commonly classified in four categories with ano-rectal involvement starting from the IIIrd degree. The objective of this study is to analyze the incidence of severe perineal lacerations and to identify possible risk factors within an Italian Tertiary Referral Maternity Hospital. This is a prospective observational cohort study based on women ≥ 32 weeks gestational age who delivered between July 2014-December 2014. Univariate analysis for parameters in relation to severe perineal tears was first performed and then logistic stepwise multivariate analysis was used including all the risk factors significant at univariate analysis (using Stata 9.0, Texas, USA). A total of 1677 women delivered in the period considered: 430 women were excluded, due to gestational age < 32 weeks (6 women) or because of abdominal delivery in 424 cases; 1247 women were included in the study. Integrum perineum was found in 233 women (18.7%), while 676 (54.2%) sustained perineal tears and 338 (27.1%) had an episiotomy. Only 15 women (1.2%) had a severe laceration, among which one IVth degree. The risk factors for severe perineal lacerations emerging in this cohort are: ethnicity, younger age, nulliparity, oxytocin augmentation and orthostatic maternal position at delivery; maternal position is the only independent risk factor emerging as significant in our multivariate logistic stepwise analysis. Above all a 1.2% prevalence rate of severe perineal laceration has been observed in an Italian Tertiary Referral maternity Hospital.

Keywords: Vaginal delivery; Severe perineal lacerations; Anal sphincter; Risk factors; Orthostatic position.