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Anal sphincter lacerations and upright delivery postures—a risk analysis from a randomized controlled trial

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Abstract

Objective

To evaluate obstetric sphincter lacerations after a kneeling or sitting position at second stage of labor in a multivariate risk analysis model.

Materials and methods

Two hundred and seventy-one primiparous women with normal pregnancies and spontaneous labor were randomized, 138 to a kneeling position and 133 to a sitting position. Medical data were retrieved from delivery charts and partograms. Risk factors were tested in a multivariate logistic regression model in a stepwise manner.

Results

The trial was completed by 106 subjects in the kneeling group and 112 subjects in the sitting group. There were no significant differences with regard to duration of second stage of labor or pre-trial maternal characteristics between the two groups. Obstetrical sphincter tears did not differ significantly between the two groups but an intact perineum was more common in the kneeling group (p<0.03) and episiotomy (mediolateral) was more common in the sitting group (p<0.05). Three grade IV sphincter lacerations occurred in the sitting group compared to none in the kneeling group (NS). Multivariate risk analysis indicated that prolonged duration of second stage of labor and episiotomy were associated with an increased risk of third- or fourth-degree sphincter tears (p<0.01 and p<0.05, respectively). Delivery posture, maternal age, fetal weight, use of oxytocin, and use of epidural analgesia did not increase the risk of obstetrical anal sphincter lacerations in the two upright postures.

Conclusion

Obstetrical anal sphincter lacerations did not differ significantly between a kneeling or sitting upright delivery posture. Episiotomy was more common after a sitting delivery posture, which may be associated with an increased risk of anal sphincter lacerations. Upright delivery postures may be encouraged in healthy women with normal, full-term pregnancy.

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Authors and Affiliations

  1. Pelvic Floor Center, Department of Obstetrics and Gynecology, Karolinska Institute Danderyd Hospital, Stockholm, Sweden

    Daniel Altman, Åsa Ekström & Sven-Eric Olsson

  2. Department of Caring and Public Health Sciences, University of Mälardalen, Västerås, Sweden

    Inga Ragnar

  3. Department of Women’s and Children’s Health, University of Uppsala, Uppsala, Sweden

    Inga Ragnar & Tanja Tydén

  4. Department of Obstetrics and Gynecology, Danderyd Hospital, 18288, Stockholm, Sweden

    Daniel Altman

Authors
  1. Daniel Altman
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  2. Inga Ragnar
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  3. Åsa Ekström
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  4. Tanja Tydén
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  5. Sven-Eric Olsson
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Corresponding author

Correspondence to Daniel Altman.

Additional information

Summary Kneeling and sitting upright during delivery does not differ significantly in pelvic floor lacerations or immediate post-partum morbidity.

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Altman, D., Ragnar, I., Ekström, Å. et al. Anal sphincter lacerations and upright delivery postures—a risk analysis from a randomized controlled trial. Int Urogynecol J 18, 141–146 (2007). https://doi.org/10.1007/s00192-006-0123-9

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  • DOI: https://doi.org/10.1007/s00192-006-0123-9

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