Does a Large Infant Head or a Short Perineal Body Increase the Risk of Obstetrical Perineal Trauma?

Overview

Journal Birth

Specialty Gynecology & Obstetrics

Date 2014 Apr 5

PMID 24698200

Citations 6

Authors

Leanne K Komorowski

Lawrence M Leeman

Anne M Fullilove

Edward J Bedrick

Laura D Migliaccio

Rebecca G Rogers

Affiliations

Soon will be listed here.

Abstract

Background: Perineal trauma after vaginal delivery can have significant long-term consequences. It is unknown if a larger infant head circumference or smaller maternal perineal anatomy are risk factors for perineal trauma after vaginal delivery.

Methods: We conducted a prospective cohort study of low-risk nulliparous women. Data collected included maternal characteristics, antepartum Pelvic Organ Prolapse Quantification measurements of the perineal body and genital hiatus, labor characteristics, perineal trauma, and infant head circumference. Perineal trauma was defined as trauma that extended into the muscles of the perineum (second-degree or deeper). Univariate and multivariate logistic models were created to calculate odds ratios (OR) and 95 percent confidence intervals (CI).

Results: We observed 448 vaginal births. Multivariate analysis demonstrated a significant association between infant head circumference at birth and perineal trauma: OR 1.22 for each increase of 1 cm in head circumference (95% CI 1.05-1.43). There was no association between perineal body or genital hiatus length and perineal trauma.

Conclusions: In nulliparous low-risk women a larger infant head circumference at birth increases the likelihood of perineal trauma, although the effect is modest. Antenatal perineal body and genital hiatus measurements do not predict perineal trauma. These results do not support alteration in mode of delivery or other obstetric practices.

Citing Articles

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Spontaneous Perineal Trauma during Non-Operative Childbirth-Retrospective Analysis of Perineal Laceration Risk Factors.

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Relationship between Perineal Body Length and Degree of Perineal Tears in Primigravidas Undergoing Vaginal Delivery with Episiotomy.

Djusad S, Purwosunu Y, Hidayat F Obstet Gynecol Int. 2021; 2021:2621872.

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Moya-Jimenez L, Sanchez-Ferrer M, Adoamnei E, Mendiola J Int Urogynecol J. 2018; 30(5):815-821.

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Pelvic floor symptoms and quality of life changes during first pregnancy: a prospective cohort study.

Rogers R, Ninivaggio C, Gallagher K, Borders A, Qualls C, Leeman L Int Urogynecol J. 2017; 28(11):1701-1707.

PMID: 28417155 PMC: 5673482. DOI: 10.1007/s00192-017-3330-7.

References

Borello-France D, Burgio K, Richter H, Zyczynski H, Fitzgerald M, Whitehead W . Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 2006; 108(4):863-72. DOI: 10.1097/01.AOG.0000232504.32589.3b. View

Albers L, Sedler K, Bedrick E, Teaf D, Peralta P . Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial. J Midwifery Womens Health. 2005; 50(5):365-72. PMC: 1350988. DOI: 10.1016/j.jmwh.2005.05.012. View

McCandlish R, Bowler U, van Asten H, Berridge G, Winter C, Sames L . A randomised controlled trial of care of the perineum during second stage of normal labour. Br J Obstet Gynaecol. 1999; 105(12):1262-72. DOI: 10.1111/j.1471-0528.1998.tb10004.x. View

Hall A, Theofrastous J, Cundiff G, Harris R, HAMILTON L, Swift S . Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system. Am J Obstet Gynecol. 1996; 175(6):1467-70; discussion 1470-1. DOI: 10.1016/s0002-9378(96)70091-1. View

Sudol-Szopinnska I, Radkiewicz J, Szopinski T, Panorska A, Jakubowski W, Kawka J . Postpartum endoanal ultrasound findings in primiparous women after vaginal delivery. Acta Radiol. 2010; 51(7):819-24. DOI: 10.3109/02841851.2010.491090. View

Rizk D, Thomas L . Relationship between the length of the perineum and position of the anus and vaginal delivery in primigravidae. Int Urogynecol J Pelvic Floor Dysfunct. 2000; 11(2):79-83. DOI: 10.1007/s001920050074. View

Goldberg J, Hyslop T, Tolosa J, Sultana C . Racial differences in severe perineal lacerations after vaginal delivery. Am J Obstet Gynecol. 2003; 188(4):1063-7. DOI: 10.1067/mob.2003.251. View

Eskandar O, Shet D . Risk factors for 3rd and 4th degree perineal tear. J Obstet Gynaecol. 2009; 29(2):119-22. DOI: 10.1080/01443610802665090. View

Deering S, Carlson N, Stitely M, Allaire A, Satin A . Perineal body length and lacerations at delivery. J Reprod Med. 2004; 49(4):306-10. View

10.

Fitzgerald M, Weber A, Howden N, Cundiff G, Brown M . Risk factors for anal sphincter tear during vaginal delivery. Obstet Gynecol. 2007; 109(1):29-34. DOI: 10.1097/01.AOG.0000242616.56617.ff. View

11.

Sorbe B, Dahlgren S . Some important factors in the molding of the fetal head during vaginal delivery--a photographic study. Int J Gynaecol Obstet. 1983; 21(3):205-12. DOI: 10.1016/0020-7292(83)90081-4. View

12.

Rathfisch G, Dikencik B, Kizilkaya Beji N, Comert N, Tekirdag A, Kadioglu A . Effects of perineal trauma on postpartum sexual function. J Adv Nurs. 2010; 66(12):2640-9. DOI: 10.1111/j.1365-2648.2010.05428.x. View

13.

Kennelly M, Anjum R, Lyons S, Burke G . Postpartum fetal head circumference and its influence on labour duration in nullipara. J Obstet Gynaecol. 2003; 23(5):496-9. DOI: 10.1080/0144361031000153701. View

14.

Bradley M, Kaminski R, Streitman D, Dunn S, Krans E . Effect of rotation on perineal lacerations in forceps-assisted vaginal deliveries. Obstet Gynecol. 2013; 122(1):132-137. PMC: 3709575. DOI: 10.1097/AOG.0b013e31829752fc. View

15.

Valsky D, Lipschuetz M, Bord A, Eldar I, Messing B, Hochner-Celnikier D . Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol. 2009; 201(1):91.e1-7. DOI: 10.1016/j.ajog.2009.03.028. View

16.

Leeman L, Fullilove A, Borders N, Manocchio R, Albers L, Rogers R . Postpartum perineal pain in a low episiotomy setting: association with severity of genital trauma, labor care, and birth variables. Birth. 2009; 36(4):283-8. PMC: 3619411. DOI: 10.1111/j.1523-536X.2009.00355.x. View

17.

Rogers R, Borders N, Leeman L, Albers L . Does spontaneous genital tract trauma impact postpartum sexual function?. J Midwifery Womens Health. 2009; 54(2):98-103. PMC: 2730880. DOI: 10.1016/j.jmwh.2008.09.001. View

18.

Austin P, Steyerberg E . Interpreting the concordance statistic of a logistic regression model: relation to the variance and odds ratio of a continuous explanatory variable. BMC Med Res Methodol. 2012; 12:82. PMC: 3528632. DOI: 10.1186/1471-2288-12-82. View

19.

Landy H, Laughon S, Bailit J, Kominiarek M, Gonzalez-Quintero V, Ramirez M . Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. Obstet Gynecol. 2011; 117(3):627-635. PMC: 3132187. DOI: 10.1097/AOG.0b013e31820afaf2. View

20.

Sheiner E, Levy A, Walfisch A, Hallak M, Mazor M . Third degree perineal tears in a university medical center where midline episiotomies are not performed. Arch Gynecol Obstet. 2004; 271(4):307-10. DOI: 10.1007/s00404-004-0610-5. View