Original Article

International Urogynecology Journal

, Volume 18, Issue 9, pp 985-990

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

  • Peter BaumannAffiliated withDepartment of Obstetrics and Gynecology, Hutzel Women’s Hospital—Detroit Medical Center, Wayne State University Email author 
  • , Ahmad O. HammoudAffiliated withDepartment of Obstetrics and Gynecology, Hutzel Women’s Hospital—Detroit Medical Center, Wayne State University
  • , Samuel Gene McNeeleyAffiliated withDepartment of Obstetrics and Gynecology, Hutzel Women’s Hospital—Detroit Medical Center, Wayne State University
  • , Elizabeth DeRoseAffiliated withDepartment of Obstetrics and Gynecology, Hutzel Women’s Hospital—Detroit Medical Center, Wayne State University
  • , Bela KudishAffiliated withDepartment of Obstetrics and Gynecology, Hutzel Women’s Hospital—Detroit Medical Center, Wayne State University
  • , Susan HendrixAffiliated withDepartment of Obstetrics and Gynecology, Hutzel Women’s Hospital—Detroit Medical Center, Wayne State University

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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.

Keywords

Body mass index Anal sphincter laceration Labor analgesia Vacuum Forceps Routine episiotomy