Risk factors for the breakdown of perineal laceration repair after vaginal delivery

The purpose of this study was to identify risk factors that are associated with the breakdown of perineal laceration repair in the postpartum period. We conducted a retrospective, case-control study to review perineal laceration repair breakdown in patients who were delivered between September 1995...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2006-09, Vol.195 (3), p.755-759
Main Authors: Williams, Meredith K., Chames, Mark C.
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Case-Control Studies
Delivery. Postpartum. Lactation
Episiotomy - adverse effects
Extraction, Obstetrical - adverse effects
Female
Gynecology. Andrology. Obstetrics
Humans
Lacerations - surgery
Logistic Models
Medical sciences
Mediolateral episiotomy
Perineal laceration
Perineum - injuries
Polyglactin 910
Postpartum Period
Pregnancy
Risk Factors
Surgical Wound Dehiscence - epidemiology
Surgical Wound Dehiscence - etiology
Sutures
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Summary:The purpose of this study was to identify risk factors that are associated with the breakdown of perineal laceration repair in the postpartum period. We conducted a retrospective, case-control study to review perineal laceration repair breakdown in patients who were delivered between September 1995 and February 2005 at the University of Michigan. Bivariate analysis with chi-square test and t-test and stepwise logistic regression analysis were performed. Fifty-nine cases and 118 control deliveries were identified from a total of 14,124 vaginal deliveries. Risk factors were longer second stage of labor (142 vs 87 minutes; P = .001), operative vaginal delivery (odds ratio, 3.6; 95% CI, 1.8-7.3), mediolateral episiotomy (odds ratio, 6.9; 95% CI, 2.6-18.7), third- or fourth-degree laceration (odds ratio, 3.1; 95% CI, 1.5-6.4), and meconium-stained amniotic fluid (odds ratio, 3.0; 95% CI, 1.1-7.9). Previous vaginal delivery was protective (odds ratio, 0.38; 95% CI, 0.18-0.84). Logistic regression showed the most significant factor to be an interaction between operative vaginal delivery and mediolateral episiotomy (odd ratio, 6.36; 95% CI, 2.18-18.57). The most significant events were mediolateral episiotomy, especially in conjunction with operative vaginal delivery, third- and fourth-degree lacerations, and meconium.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2006.06.085