Obstetric perineal tears: risk factors, wound infection and dehiscence: a prospective cohort study
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To assess risk factors for perineal tears, wound infection and dehiscence among primiparous women.
A prospective cohort study at four Danish hospitals (Odense, Esbjerg, Aarhus and Kolding) among 603 primiparous women sampled in three groups: 203 with none/labia/1st degree, 200 with 2nd degree, and 200 with 3rd/4th degree tears included between July 2015 and January 2018. Baseline data were obtained and a clinical examination of perineal wound healing was performed 11–21 days postpartum. Main outcome measurements were as follows: degree of perineal tear, 1st to 4th, analyzed with a case–control approach, infection (purulent drainage or wound abscess), and wound dehiscence (a gap between wound edges > 0.5 cm).
Instrumental delivery and birthweight > 4000 g increased the risk of 3rd/4th degree tears (adjusted Odds Ratio [aOR] 13.7, 95% confidence interval [CI] 5.48–34.1 and aOR 3.27, 95% CI 1.52–7.04, respectively). BMI > 35 kg/m2 increased the risk of wound infection and dehiscence (aOR 7.66, 95% CI 2.13–27.5 and aOR 3.46, 95% CI 1.10–10.9, respectively). Episiotomy tripled the risk of infection (aOR 2.97, 95% CI 1.05–8.41). Treatment with antibiotics during delivery and postpartum seemed to decrease the risk of dehiscence (aOR 0.32, 95% CI 0.15–0.70).
Instrumental delivery and high birth weight increased the risk of perineal tears. Severe obesity and episiotomy increased the risk of perineal wound complications. More focus on these women may be warranted postpartum. The use of prophylactic antibiotics among women in high risk of wound complications should be further investigated in interventional studies.
KeywordsBirth trauma Perineal trauma Perineal care Wound infection Wound dehiscence
DG, VR, HD, NQ and EAN contributed to the design of this study. DG performed the data collection and conducted the analyses and DG, VR, NQ and EAN contributed to the interpretation of data. DG drafted the manuscript and DG, VR, HD, NQ and EAN critically revised the manuscript and approved the version to be published.
The study was funded by A.P. Møller and wife Chastine Mc-Kinney Møllers foundation, Odense University hospitals research foundation, The Region of Southern Denmark’s research foundation and The Danish Association of Midwives. A one-year PhD fellowship was assigned from University of Southern Denmark. Another year was assigned from the Research Foundations PhD pool at Region of Southern Denmark and a year assigned from the Department of Gynecology and Obstetrics, Odense University hospital. None of the funders played any role in conducting research or writing the paper. The study was funded by Odense University hospitals research foundation, The Region of Southern Denmark, University of Southern Denmark, the department of Gynecology and Obstetrics, Odense University hospital, A.P. Møller and wife Chastine Mc-Kinney Møllers foundation and The Danish Association of Midwives
Compliance with ethical standards
All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. The study was approved by the Scientific Ethics Committee for the Region of Southern Denmark (S-20120213, 14.5.2013) and by the Danish Data Protection Agency (ID-2008-58-0035, 14.1.2015).
Informed consent was obtained from all individual participants in the study.
Conflict of interest
The authors report no conflict of interests.
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