Skip to main content

Advertisement

SpringerLink
Log in

Determinants of the length of episiotomy or spontaneous posterior perineal lacerations during vaginal birth

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

The objective of this study was to measure the length of episiotomy or spontaneous posterior perineal laceration and their relationship to perineal measurements and obstetric variables. The length of the perineum and genital hiatus and vertical length of episiotomy or posterior perineal tears were measured in 114 consecutive parturients with spontaneous singleton term deliveries. Seventy-four (65%) women underwent episiotomy while 40 (35%) sustained spontaneous posterior tears. Perineal or genital hiatus length was significantly correlated to episiotomy (r=0.34, p=0.003) or laceration (r=0.37, p=0.02) length, respectively. This association was significant (p=0.001) in a generalized linear model with duration of second stage of labor (p=0.005), degree of tear (p=0), and parity (p=0). Perineal length was significantly related to maternal age (p=0.036) and weight (p=0.037) and hiatal length (p=0). Short perineum and genital hiatus, long second stage of labor, and low parity are associated with longer posterior perineal injury.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Richter HE, Brumfield CG, Cliver SP, Burgio KL, Neely CL, Varner RE (2002) Risk factors associated with anal sphincter tear: a comparison of primiparous patients, vaginal births after cesarean deliveries, and patients with previous vaginal delivery. Am J Obstet Gynecol 187:1194–1198

    Article  PubMed  Google Scholar 

  2. Handa VL, Danielsen BH, Gilbert WM (2001) Obstetric anal sphincter lacerations. Obstet Gynecol 95:225–230

    Article  Google Scholar 

  3. Nager CW, Helliwell JP (2001) Episiotomy increases perineal laceration length in primiparous women. Am J Obstet Gynecol 185:444–450

    Article  CAS  PubMed  Google Scholar 

  4. Signorello LB, Harlow BL, Chekos AK, Repke JT (2000) Midline episiotomy and anal incontinence: retrospective cohort study. BMJ 320:86–90

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Christianson LM, Bovbjerg VE, McDavitt EC, Hullfish KL (2003) Risk factors for perineal injury during delivery. Am J Obstet Gynecol 189:255–260

    Article  CAS  PubMed  Google Scholar 

  6. de Leeuw JW, Struijk PC, Vierhout ME, Wallenburg HC (2001) Risk factors for third degree perineal ruptures during delivery. Br J Obstet Gynaecol 108:383–387

    Google Scholar 

  7. Pinta TM, Kylanpaa ML, Salmi TK, Teramo KA, Luukkonen PS (2004) Primary sphincter repair: are the results of the operation good enough? Dis Colon Rectum 47:18–23

    Article  PubMed  Google Scholar 

  8. de Parades V, Etienney I, Thabut D, Beaulieu S, Tawk M, Assemekang B et al (2004) Anal sphincter injury after forceps delivery: myth or reality? A prospective ultrasound study of 93 females. Dis Colon Rectum 47:24–34

    Article  PubMed  Google Scholar 

  9. Fleming N, Newton ER, Roberts J (2003) Changes in postpartum perineal muscle function in women with and without episiotomies. J Midwifery Womens Health 48:53–59

    Article  PubMed  Google Scholar 

  10. Cleary-Goldman J, Robinson JN (2003) The role of episiotomy in current obstetric practice. Semin Perinatol 27:3–12

    Article  PubMed  Google Scholar 

  11. Howard D, Davies PS, Delancey JOL, Small Y (2000) Differences in perineal lacerations in black and white primiparas. Obstet Gynecol 96:622–624

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO (2003) Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 189:1543–1549

    Article  PubMed  Google Scholar 

  13. Klein MC, Gauther RJ, Robbins JM, Kaczorowski J, Jorgensen SH, Franco ED et al (1994) Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol 171:591–598

    Article  CAS  PubMed  Google Scholar 

  14. Woolley RJ (1995) Benefits and risks of episiotomy: a review of the English-language literature since 1980. Obstet Gynecol Surv 50:806–835

    Article  CAS  PubMed  Google Scholar 

  15. Thaker SB, Banta HD (1983) Benefits and risks of episiotomy: an interpretative review of the English language literature, 1860–1980. Obstet Gynecol Surv 38:322–338

    Article  Google Scholar 

  16. Lede RL, Belizan JM, Carroli G (1996) Is routine use of episiotomy justified? Am J Obstet Gynecol 174:1399–1402

    Article  CAS  PubMed  Google Scholar 

  17. Eason E, Labrecque M, Wells G, Feldman P (2000) Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol 95:464–471

    Article  CAS  PubMed  Google Scholar 

  18. Carroli G, Belizan J (2003) Episiotomy for vaginal birth. Cochrane Database of Syst Rev (3):CD000081

    Google Scholar 

  19. Angioli R, Gomez-Marin O, Cantuaria G, O’sullivan MJ (2000) Severe perineal lacerations during vaginal delivery: the University of Miami experience. Am J Obstet Gynecol 182:1083–1085

    Article  CAS  PubMed  Google Scholar 

  20. Goldberg J, Hyslop T, Tolosa JE, Sultana C (2003) Racial differences in severe perineal lacerations after vaginal delivery. Am J Obstet Gynecol 188:1063–1067

    Article  PubMed  Google Scholar 

  21. Riskin-Mashiah S, O’Brian SE, Wilkins IA (2002) Risk factors for severe perineal tear: can we do better? Am J Perinatol 19:225–234

    Article  PubMed  Google Scholar 

  22. Bodner-Adler B, Bodner K, Kaider A, Wagenbichler P, Leodolter S, Husslein P et al (2001) Risk factors for third-degree perineal tears in vaginal delivery, with an analysis of episiotomy types. J Reprod Med 46:752–756

    CAS  PubMed  Google Scholar 

  23. Poen AC, Felt-Bersma RJ, Dekker GA, Deville W, Cuesta MA, Meuwissen SG (1997) Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy. Br J Obstet Gynaecol 104:563–566

    Article  CAS  PubMed  Google Scholar 

  24. Sartore A, De Seta F, Maso G, Pregazzi R, Grimaldi E, Guaschino S (2004) The effects of mediolateral episiotomy on pelvic floor function after vaginal delivery. Obstet Gynecol 103:669–673

    Article  PubMed  Google Scholar 

  25. Rizk DE, Thomas L (2000) Relationship between the length of the perineum and position of the anus and vaginal delivery in primigravidae. Int Urogynecol J 11:79–83

    Article  CAS  Google Scholar 

  26. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    Article  CAS  PubMed  Google Scholar 

  27. Cundiff GW, Harris RL, Coates K, Low VHS, Bump RC, Addison WE (1997) Abdominal sacral colpoperineopexy: a new approach for correction of posterior compartment defects and perineal descent associated with vaginal vault prolapse. Am J Obstet Gynecol 177:1345–1355

    Article  CAS  PubMed  Google Scholar 

  28. Delancey JO, Hurd WW (1998) Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse. Obstet Gynecol 91:364–368

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Professor M. Ezimokhai for critical review of the manuscript.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, United Arab Emirates University, 17666, Al-Ain, United Arab Emirates

    Diaa E. E. Rizk & Letha B. Thomas

  2. Department of Obstetrics and Gynecology, Al-Ain Hospital, Al-Ain, United Arab Emirates

    Mary N. Abadir

  3. Department of Surgery, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates

    Fikri Abu-Zidan

Authors
  1. Diaa E. E. Rizk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary N. Abadir
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Letha B. Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fikri Abu-Zidan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Diaa E. E. Rizk.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rizk, D.E.E., Abadir, M.N., Thomas, L.B. et al. Determinants of the length of episiotomy or spontaneous posterior perineal lacerations during vaginal birth. Int Urogynecol J 16, 395–400 (2005). https://doi.org/10.1007/s00192-004-1273-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-004-1273-2

Keywords

Search

Navigation