Ohad Gluck1, Hadas Ganer Herman2, Ori Tal2, Ehud Grinstein2, Jacob Bar2, Michal Kovo2, Shimon Ginath2, Eran Weiner2. 1. Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel. ohadgluck@gmail.com. 2. Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel.
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.
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.
Authors: Andreas F Schaub; Mario Litschgi; Irene Hoesli; Wolfgang Holzgreve; Ulrich Bleul; Verena Geissbühler Journal: J Perinat Med Date: 2008 Impact factor: 1.901
Authors: Helain J Landy; S Katherine Laughon; Jennifer L Bailit; Michelle A Kominiarek; Victor Hugo Gonzalez-Quintero; Mildred Ramirez; Shoshana Haberman; Judith Hibbard; Isabelle Wilkins; D Ware Branch; Ronald T Burkman; Kimberly Gregory; Matthew K Hoffman; Lee A Learman; Christos Hatjis; Paul C VanVeldhuisen; Uma M Reddy; James Troendle; Liping Sun; Jun Zhang Journal: Obstet Gynecol Date: 2011-03 Impact factor: 7.661