K Gottvall1, P Allebeck, C Ekéus. 1. Department of Women and Child Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden. karin.gottvall@ki.se
Abstract
OBJECTIVE: To assess the role of birth position in the occurrence of anal sphincter tears (AST). DESIGN: Observational cohort study. SETTING: South Hospital in Stockholm, a teaching hospital with around 5700 births per year. POPULATION: Among all 19,151 women who gave birth at the South Hospital during the study period 2002-05, 12,782 women met the inclusion criteria of noninstrumental, vaginal deliveries. METHODS: Data on birth position and other obstetric factors were analysed in relation to occurrence of AST. MAIN OUTCOME MEASURE: Third- and fourth-degree AST. RESULTS: AST occurred in 449 women (3.5%). The trauma was more frequent in primiparous (5.8%) than in multiparous women (1.7%). The highest proportion of AST was found among women who gave birth in lithotomy position (6.9%), followed by squatting position (6.4%). Logistic regression analyses showed that lithotomy (adjusted OR 2.02, 95% CI 1.58-2.59) and squatting positions (adjusted OR 2.05, 95% CI 1.09-3.82) were associated with a significantly increased risk for AST. Other major risk factors for anal sphincter trauma were primiparity (adjusted OR 3.29, 95% CI 2.55-4.25), prolonged second stage of labour >1 hour (adjusted OR 1.52, 95% CI 1.11-2.10), infant birthweight more than 4 kg (adjusted OR 2.12, 95% CI 1.64-2.72) and large infant head circumference (adjusted OR 1.57, 95% CI 1.23-1.99). CONCLUSION: Lithotomy and squatting position at birth were associated with an increased risk for AST also after control for other risk factors.
OBJECTIVE: To assess the role of birth position in the occurrence of anal sphincter tears (AST). DESIGN: Observational cohort study. SETTING: South Hospital in Stockholm, a teaching hospital with around 5700 births per year. POPULATION: Among all 19,151 women who gave birth at the South Hospital during the study period 2002-05, 12,782 women met the inclusion criteria of noninstrumental, vaginal deliveries. METHODS: Data on birth position and other obstetric factors were analysed in relation to occurrence of AST. MAIN OUTCOME MEASURE: Third- and fourth-degree AST. RESULTS: AST occurred in 449 women (3.5%). The trauma was more frequent in primiparous (5.8%) than in multiparous women (1.7%). The highest proportion of AST was found among women who gave birth in lithotomy position (6.9%), followed by squatting position (6.4%). Logistic regression analyses showed that lithotomy (adjusted OR 2.02, 95% CI 1.58-2.59) and squatting positions (adjusted OR 2.05, 95% CI 1.09-3.82) were associated with a significantly increased risk for AST. Other major risk factors for anal sphincter trauma were primiparity (adjusted OR 3.29, 95% CI 2.55-4.25), prolonged second stage of labour >1 hour (adjusted OR 1.52, 95% CI 1.11-2.10), infant birthweight more than 4 kg (adjusted OR 2.12, 95% CI 1.64-2.72) and large infant head circumference (adjusted OR 1.57, 95% CI 1.23-1.99). CONCLUSION: Lithotomy and squatting position at birth were associated with an increased risk for AST also after control for other risk factors.
Authors: T Aigmueller; W Bader; K Beilecke; K Elenskaia; A Frudinger; E Hanzal; H Helmer; H Huemer; M van der Kleyn; D Koelle; S Kropshofer; J Pfeiffer; C Reisenauer; A Tammaa; K Tamussino; W Umek Journal: Geburtshilfe Frauenheilkd Date: 2015-02 Impact factor: 2.915
Authors: T Aigmueller; W Umek; K Elenskaia; A Frudinger; J Pfeifer; H Helmer; H Huemer; A Tammaa; M van der Kleyn; K Tamussino; D Koelle Journal: Int Urogynecol J Date: 2012-11-17 Impact factor: 2.894