Risk factors associated with severe perineal lacerations during vaginal delivery: A 10 years propensity score-matched observational study

• DOI: 10.21203/rs.3.rs-1569080/v1
• Publication Date: 2022-05-18T18:25:50Z
• Authors: Valentina LAURITA...; Emmanuel Nene ODJ...; Brigida CARDUCCI; Bruno Antonio ZAN...; Stefano CATARCI; Gaetano DRAISCI; Antonio LANZONE; Elisa BEVILACQUA
• Keywords: Episiotomy; Cephalic presentation; Univariate analysis

Abstract BACKGROUND: Severe perineal lacerations are rare obstetric complications in high-income countries, yet, their prevention is crucial due to long-term consequences on woman digestive function, sexual-mental health and wellbeing. This study aims assess the incidence of anal sphincter injuries at a single institution over period ten years identifying women more risk by evaluating relationship between antenatal intrapartum factors severe tears. METHODS: was an observational retrospective cohort carried out University Teaching Hospital Italy 2009-2019 using prospectively maintained database. The included all with singleton pregnancy term who delivered vaginal delivery cephalic presentation. Two stages comprised data analysis: propensity score matching stepwise univariate multivariate logistic regression. A secondary analysis performed further evaluate effect parity, epidural anaesthesia duration second stage.RESULTS: Of 41,440 patients screened for eligibility, 22,156 met inclusion criteria. Among them, occurred 81 (0.4%) cases: 51 (0.3%) after spontaneous 30 (0.5%) vacuum delivery. There increased odd nulliparous delivering (aOR 2.85, 95% CI 1.19,6.81; p=0.019), reciprocal reduction multiparous 0.35, 0.15,0.84; Epidural episiotomy were associated lower 0.54, 0.33, 0.86; p=0.011; 0.20, 0.11, 0.36; p <0.001). independent from 2nd stage 1.0, 0.99, 1.0; p=0.3). Neonatal include head circumference (OR 1.5, 1.18,1.90; p=0.001) vertex malpresentation 2.71, 1.08,6.78; p=0.033). Induction labour 1.13, 95%CI 0.72, 1.92 p=0.6), frequent examinations 1.17, 1.9 p=0.5), women’s supine station birth additional contributors 1.25, 0.61, 2.55 p=0.5). Amongst complications, shoulder dystocia nearly four times 3.92, 0.5 ,30.74; p= 0.2) whilst postpartum hemorrhage three often cases complicated 3.35, 1.76,6.40; p<0.001). association injuries, parity use confirmed analysis. We found that primipara without had highest 2.53, 1.46, 4.39; p=0.001)CONCLUSIONS: complication Using robust statistical model, we investigated broad range factors, including usually underreported. first time