Abstract
Purpose
To study the association between the number of vaginal examinations (VEs) performed during labor and subsequent severe perineal trauma.
Methods
This is a retrospective cohort study. We included all women admitted to the delivery ward between 2008 and 2017, in active labor. Exclusion criteria included preterm deliveries (< 37 weeks), Cesarean deliveries and episiotomy during delivery.
The primary outcome, severe perineal trauma, was defined as perineal tears grades 3–4.
The cohort was divided into 4 groups, based on the number of VEs performed during labor: Group 1—up to two VEs (n = 4588), Group 2—three to four VEs (n = 5815), Group 3—five to six VEs (n = 4687), and Group 4—seven or more VEs (n = 7297).
Results
Overall, 22,387 women were included in the study. The rate of severe perineal trauma in groups 1, 2, 3 and 4 was 0.4%, 0.1%, 0.8%, and 0.4%, respectively (p < 0.001).
Performing five or more VEs during labor was associated with a higher risk of severe perineal trauma (0.26% vs. 0.53%, p < 0.01), as compared to four VEs or less.
Using a logistic regression model, we found that performing five or more VEs during labor (aOR = 1.72 CI 95% (1.21–2.47), p < 0.001) or performing an instrumental delivery (aOR = 2.65 CI 95% (1.72–4.07), p < 0.001) were directly associated with the risk for severe perineal trauma. Applying epidural anesthesia showed an inverse association with severe perineal trauma (aOR = 0.54 CI 95% (0.38–0.77), p < 0.001).
Conclusion
Performing five or more VEs during active labor is associated with an increased risk for severe perineal trauma.
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Acknowledgements
Meir Azran, Computing and Information Systems, E. Wolfson Medical Center, Holon, Israel. Ela Smirin, archive, E. Wolfson Medical Center, Holon, Israel. Performing five or more VEs during active labor is associated with an increased risk for severe perineal trauma.
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This study was not funded.
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O. Gluck and E. Weiner: Project development and manuscript writing. H. Ganer Herman and O. Tal: Data collection and management. E. Grinstein: Data analysis and manuscript editing. J. Bar and M. Kovo: Literature review and concept development. S. Ginath: Manuscript editing and protocol development.
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Gluck, O., Ganer Herman, H., Tal, O. et al. The association between the number of vaginal examinations during labor and perineal trauma: a retrospective cohort study. Arch Gynecol Obstet 301, 1405–1410 (2020). https://doi.org/10.1007/s00404-020-05552-z
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DOI: https://doi.org/10.1007/s00404-020-05552-z