Skip to main content
Log in

Factors associated with anal sphincter laceration in 40,923 primiparous women

International Urogynecology Journal Aims and scope Submit manuscript

Abstract

The objective of this study was to identify factors associated with anal sphincter laceration in primiparous women. A subpopulation of 40,923 primiparous women at term with complete data sets was abstracted from a state-wide perinatal database in Germany. Outcome variable was anal sphincter laceration. Independent variables were 17 known obstetrical risk factors/conditions/interventions impacting childbirth recorded on the perinatal data collection sheet. Cross table analysis followed by logistic regression analysis was used for data analysis. Logistic regression showed episiotomy (OR, 3.23; CI, 2.73–3.80) and forceps delivery (OR, 2.68, CI, 2.17–3.33) to be most strongly associated with anal sphincter laceration. Women with a BMI ≥ 30 kg/m2, and smokers had a significantly lower risk of anal sphincter laceration. Local, pudendal, and epidural analgesia all reduced the risk of anal sphincter laceration. Iatrogenic factors most strongly associated with anal sphincter laceration in primiparous women include routine episiotomy and forceps delivery.

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

Access this article

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) http://www.jointcommission.org/NR/rdonlyres/F438F258-BDEE-4A11-A632-27FC193C73CE/0/2zr_PR3.pdf

  2. 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 (discussion 1549–1550)

    Article  PubMed  Google Scholar 

  3. Beckmann MM, Garrett AJ (2006) Antenatal perineal massage for reducing perineal trauma. Birth 33:159

    Article  Google Scholar 

  4. Eogan M, Daly L, O’Herlihy C (2006) The effect of regular antenatal perineal massage on postnatal pain and anal sphincter injury: a prospective observational study. J Matern Fetal Neonatal Med 19:225–229

    PubMed  Google Scholar 

  5. Goodell W (1871) A critical inquiry into the management of the perineum during labor. Am J Med Sci 61:53

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  7. Dandolu V, Chatwani A, Harmanli O, Floro C, Gaughan JP, Hernandez E (2005) Risk factors for obstetrical anal sphincter lacerations. Int Urogynecol J Pelvic Floor Dysfunct 16(4):304–307

    Article  PubMed  Google Scholar 

  8. Handa VL, Harris TA, Ostergard DR (1996) Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse. Obstet Gynecol 88:470–478

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  10. Handa VL, Danielsen BH, Gilbert WM (2001) Obstetric anal sphincter lacerations. Obstet Gynecol 98:225–230

    Article  PubMed  CAS  Google Scholar 

  11. Hsieh FY (1989) Sample size tables for logistic regression. Stat Med

  12. Hudelist G, Gelle’n J, Singer C, Ruecklinger E, Czerwenka K, Kandolf O, Keckstein J (2005) Factors predicting severe perineal trauma during childbirth: role of forceps delivery routinely combined with mediolateral episiotomy. Am J Obstet Gynecol 192:875–881

    Article  PubMed  Google Scholar 

  13. Broomall A (1878) The operation of episiotomy as a prevention of perineal ruptures during labor. Am J Obstet 11:517–527

    Google Scholar 

  14. Credé uC (1884) Ueber die Zweckmässigkeit der einseitigen seitlichen Incision beim Dammschutzverfahren. Archiv für Gynäkologie 24(150):148–168

    Article  Google Scholar 

  15. Thacker 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  PubMed  CAS  Google Scholar 

  16. Shiono P, Klebanoff MA, Carey JC (1990) Midline episiotomies: more harm than good? Obstet Gynecol 75:765–770

    PubMed  CAS  Google Scholar 

  17. Coats PM, Chan KK, Wilkins M, Beard RJ (1980) A comparison between midline and mediolateral episiotomies. Br J Obstet Gynaecol 87:408–412

    PubMed  CAS  Google Scholar 

  18. Samuelsson E, Ladfors L, Wennerholm UB, Gareberg B, Nyberg K, Hagberg H (2000) Anal sphincter tears: prospective study of obstetric risk factors. BJOG 107:926–931

    Article  PubMed  CAS  Google Scholar 

  19. Burrows LJ CG, Leffler KS, Witter FR (2004) Predictors of third and fourth-degree perineal lacerations. J Pelvic Med Surg 10:15–17

    Article  Google Scholar 

  20. Cheng YW, Hopkins LM, Caughey AB (2004) How long is too long: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes? Am J Obstet Gynecol 191:933–938

    Article  PubMed  Google Scholar 

  21. Fitzpatrick M, Harkin R, McQuillan K, O’Brien C, O’Connell PR, O’Herlihy C (2002) A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal continence. BJOG 109:1359–1365

    Article  PubMed  Google Scholar 

  22. Klein MC, Janssen PA, MacWilliam L, Kaczorowski J, Johnson B (1997) Determinants of vaginal-perineal integrity and pelvic floor functioning in childbirth. Am J Obstet Gynecol 176:403–410

    Article  PubMed  CAS  Google Scholar 

  23. Hansen SL, Clark SL, Foster JC (2002) Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial. Obstet Gynecol 99:29–34

    Article  PubMed  Google Scholar 

  24. Robinson JN, Norwitz ER, Cohen AP, McElrath TF, Lieberman ES (1999) Epidural analgesia and third- or fourth-degree lacerations in nulliparas. Obstet Gynecol 94:259–262

    Article  PubMed  CAS  Google Scholar 

  25. Anotayanonth S, Subhedar NV, Garner P, Neilson JP, Harigopal S (2004) Betamimetics for inhibiting preterm labour. Cochrane Database Syst Rev: CD004352

  26. Wischnik A, Mendler N, Schroll A, Heimisch W, Weidenbach A (1982) [The cardiac hazard of tocolysis and antagonizing possibilities. II. Communication: protection of the myocardium by means of substitution of magnesium]. Geburtshilfe Frauenheilkd 42:537–542

    PubMed  CAS  Google Scholar 

  27. Mosler KH (1975) The treatment of threatened premature labor by tocolytics, Ca++-antagonists and anti-inflammatory drugs. Arzneimittelforschung 25:263–266

    PubMed  CAS  Google Scholar 

  28. Wischnik A, Mendler N, Heimisch W, Schroll A, Weidenbach A (1982) [The cardiac hazard of tocolysis and antagonising possibilities. I. The haemodynamic situation of the patient during tocolysis/Protection of the myocardium by means of cardioselective beta-blockade. Experimental results]. Geburtshilfe Frauenheilkd 42:286–290 (author’s transl)

    PubMed  CAS  Google Scholar 

  29. Domino EF (1986) Nicotine: a unique psychoactive drug-arousal with skeletal muscle relaxation. Psychopharmacol Bull 22:870–874

    PubMed  CAS  Google Scholar 

  30. Domino EF, Kadoya C, Matsuoka S (1994) Recovery cycle of the Hoffmann reflex of tobacco smokers and nonsmokers: relationship to plasma nicotine and cotinine levels. Eur J Clin Pharmacol 46:527–532

    Article  PubMed  CAS  Google Scholar 

  31. Bujold E, Hammoud A, Schild C, Krapp M, Baumann P (2005) The role of maternal body mass index in outcomes of vaginal births after cesarean. Am J Obstet Gynecol 193:1517–1521

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  33. Carroll TG, Engelken M, Mosier MC, Nazir N (2003) Epidural analgesia and severe perineal laceration in a community-based obstetric practice. J Am Board Fam Pract 16:1–6

    Article  PubMed  Google Scholar 

  34. de Lange JJ, Cuesta MA, Cuesta de Pedro A (1994) Fidel pages mirave (1886–1923). The pioneer of lumbar epidural anaesthesia. Anaesthesia 49:429–431

    Article  PubMed  Google Scholar 

  35. Tan TK (1998) Epidural analgesia in obstetrics. Ann Acad Med Singap 27:235–242

    PubMed  CAS  Google Scholar 

  36. Ural SH, Roshanfekr D, Witter FR (2000) Fourth-degree lacerations and epidural anesthesia. Int J Gynaecol Obstet 71:231–233

    Article  PubMed  CAS  Google Scholar 

  37. Walker MP, Farine D, Rolbin SH, Ritchie JW (1991) Epidural anesthesia, episiotomy, and obstetric laceration. Obstet Gynecol 77:668–671

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This study was conducted at Wayne State University, Detroit, Michigan.

There was no funding associated with this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter Baumann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baumann, P., Hammoud, A.O., McNeeley, S.G. et al. Factors associated with anal sphincter laceration in 40,923 primiparous women. Int Urogynecol J 18, 985–990 (2007). https://doi.org/10.1007/s00192-006-0274-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-006-0274-8

Keywords

Navigation