Risk factors for severe perineal lacerations during childbirth

Abstract

BACKGROUND: Severe perineal lacerations represent a significant complication of normal labor with a strong impact on quality of life. OBJECTIVES: To identify factors that lead to the occurrence of severe perineal lacerations. SEARCH STRATEGY: We searched MEDLINE, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Google Scholar and reference lists from all included studies. SELECTION CRITERIA: We included prospective and retrospective observational studies. DATA COLLECTION AND ANALYSIS: Predetermined data were collected and analyzed with the Mantel-Haenszel fixed-effects model or the DerSimonian-Laird random-effects model. MAIN RESULTS: The meta-analysis included 22 studies (n=651,934). Women with severe perineal tears were more likely to have had heavier infants (mean difference 192.88 g [95% CI, 139.80-245.96 g]), an episiotomy (OR 3.82 [95% CI, 1.96-7.42]), or an operative vaginal delivery (OR 5.10 [95% CI, 3.33-7.83]). Epidural anesthesia (OR 1.95 [95% CI, 1.63-2.32]), labor induction (OR 1.08 [95% CI, 1.02-1.14]), and labor augmentation (OR 1.95 [95% CI, 1.56-2.44]) were also more common among women with perineal lacerations. CONCLUSIONS: Various factors contribute to the occurrence of perineal lacerations. Future studies should consistently evaluate all examined parameters to determine their possible interrelation.