Cent Eur J Nurs Midw 2021, 12(1):257-266 | DOI: 10.15452/cejnm.2020.11.0040

Perineal tears sustained during vaginal birth: a cross-sectional study

Jaqueline Sousa Leite1, Adriana Caroci-Becker2, Victor Hugo Alves Mascarenhas3, Maria Luiza Gonzalez Riesco4
1 Adventist University Center of São Paulo, São Paulo, Brazil
2 School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
3 School of Nursing, University of São Paulo, São Paulo, Brazil
4 Maternal-Child and Psychiatric Nursing Department, School of Nursing, University of São Paulo, São Paulo, Brazil

Aim:  To analyse the type, location, degree, shape and size of perineal tears sustained during normal birth. Design: Cross-sectional study. Methods: The sample was composed of 100 women with perineal tears whose length and depth were measured using the tool Peri-Rule™. Bivariate and multivariate analyses were carried out using a significance level of 5% (p = 0.05). Results: Similar numbers of women sustained single or multiple tears (51% vs 49%). Perineal tears occurred more frequently in the posterior than anterior region of the perineum (80% vs 58%). In 77.5%, 20.0% and 2.5% of the women, first-, second- and third-degree tears, respectively, occurred in the posterior region of the perineum, with over half of them having straight-line tears (62.5%), approximately one third having U-shaped tears (35.0%) and a minority having star-shaped tears (2.5%). Perineal oedema during labour (OR = 5.31) remained an independent predictor of second-degree tears. Infant birth weight (RC = -1.32), perineal body length (RC = 0.41) and oxytocin use (RC = -6.44) were statistically significantly associated with the size of perineal tears sustained. Conclusion: Perineal tears following normal birth were most likely of the first degree, straight-line and occurred mainly in the posterior region of the perineum. The degree, length and depth of the tears varied according to the location.

Keywords: lacerations, midwifery, obstetrics, parturition, perineum

Received: July 7, 2020; Revised: November 24, 2020; Accepted: December 31, 2020; Published: March 5, 2021  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Leite JS, Caroci-Becker A, Alves Mascarenhas VH, Gonzalez Riesco ML. Perineal tears sustained during vaginal birth: a cross-sectional study. Central European Journal of Nursing and Midwifery. 2021;12(1):257-266. doi: 10.15452/cejnm.2020.11.0040.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Albers, L., Garcia, J., Renfrew, M., McCandlish, R., & Elbourne, D. (1999). Distribution of genital tract trauma in childbirth and related postnatal pain. Birth, 26(1), 11-17. https://doi.org/10.1046/j.1523-536x.1999.00011.x Go to original source... Go to PubMed...
    2. Albers, L. L., Sedler, K. D., Bedrick, E. J., Teaf, D., & Peralta, P. (2006). Factors related to genital tract trauma in normal spontaneous vaginal births. Birth, 33(2), 94-100. https://doi.org/10.1111/j.0730-7659.2006.00085.x Go to original source... Go to PubMed...
    3. Brohi, Z. P., Sadaf, A., Zohra, N., & Perveen, U. (2012). Frequency and severity of perineal tears in Countess Lady Duffrin Fund Hospital, Hyderabad. The Journal of the Pakistan Medical Association, 62(8), 803-806. https://jpma.org.pk/article-details/3611?article_id=3611 Go to PubMed...
    4. Caroci, A., Riesco, M. L., Rocha, B. M., Ventura, L., & Oliveira, S. G. (2014). Evaluation of perineal muscle strength in the first trimester of pregnancy. Revista Latino-americana de Enfermagem, 22(6), 893-901. https://doi.org/10.1590/0104-1169.3600.2492 Go to original source... Go to PubMed...
    5. Carroli, G., & Mignini, L. (2009). Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews, (1), CD000081. https://doi.org/10.1002/14651858.cd000081.pub2 Go to original source... Go to PubMed...
    6. Colacioppo, P. M., Riesco, M. L. G., & Koiffman, M. D. (2011). Use of hyaluronidase to prevent perineal trauma during spontaneous births: a randomized, placebo-controlled, double-blind, clinical trial. Journal of Midwifery & Womenʼs Health, 56(5), 436-445. https://doi.org/10.1111/j.1542-2011.2011.00056.x Go to original source... Go to PubMed...
    7. Crookall, R., Fowler, G., Wood, C., & Slade, P. (2018). A systematic mixed studies review of womenʼs experiences of perineal trauma sustained during childbirth. Journal of Advanced Nursing, 74(9), 2038-2052. https://doi.org/10.1111/jan.13724 Go to original source... Go to PubMed...
    8. Elharmeel, S. M. A., Chaudhary, Y., Tan, S., Scheermeyer, E., Hanafy, A., & van Driel, M. L. (2011). Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention. The Cochrane Database of Systematic Reviews, (8), CD008534. https://doi.org/10.1002/14651858.CD008534.pub2 Go to original source... Go to PubMed...
    9. Geller, E. J., Robinson, B. L., Matthews, C. A., Celauro, K. P., Dunivan, G. C., Crane, A. K., Ivins, A. R., Woodham, P. C., & Fielding, J. R. (2014). Perineal body length as a risk factor for ultrasound-diagnosed anal sphincter tear at first delivery. International Urogynecology Journal, 25(5), 631-636. https://doi.org/10.1007/s00192-013-2273-x Go to original source... Go to PubMed...
    10. Hudelist, G., Gelle'n, J., Singer, C., Ruecklinger, E., Czerwenka, K., Kandolf, O., & Keckstein, J. (2005). Factors predicting severe perineal trauma during childbirth: role of forceps delivery routinely combined with mediolateral episiotomy. American Journal of Obstetrics and Gynecology, 192(3), 875-881. https://doi.org/10.1016/j.ajog.2004.09.035 Go to original source... Go to PubMed...
    11. Ismail, K. M. K., Kettle, C., Macdonald, S. E., Tohill, S., Thomas, P. W., & Bick, D. (2013). Perineal assessment and repair longitudinal study (PEARLS): a matched-pair cluster randomized trial. BMC Medicine, 11, 209. https://doi.org/10.1186/1741-7015-11-209 Go to original source... Go to PubMed...
    12. Jiang, H., Qian, X., Carroli, G., & Garner, P. (2017). Selective versus routine use of episiotomy for vaginal birth. Cochrane Database of Systematic Reviews, 2(2), CD000081. https://doi.org/10.1002/14651858.CD000081.pub3 Go to original source... Go to PubMed...
    13. Kettle, C., Dowswell, T., & Ismail, K. M. K. (2012). Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears. The Cochrane Database of Systematic Reviews, 11(11), CD000947. https://doi.org/10.1002/14651858.CD000947.pub3 Go to original source... Go to PubMed...
    14. Kutner, M. H., Nachtsheim, C. J., Neter, J., & Li, W. (2005). Applied Linear Statistical Models (5th ed.). McGraw-Hill.
    15. Lemos, A., Amorim, M. M. R., de Andrade, A. D., de Souza, A. I., Cabral Filho, J. E., & Correia, J. B. (2017). Pushing/bearing down methods for the second stage of labour. The Cochrane Database of Systematic Reviews, 3(3), CD009124. https://doi.org/10.1002/14651858.CD009124.pub3 Go to original source... Go to PubMed...
    16. Lwanga, S. K. & Lemeshow, S. (‎1991)‎. Sample size determination in health studies: a practical manual. World Health Organization. https://apps.who.int/iris/handle/10665/40062
    17. Metcalfe, A., Tohill, S., Williams, A., Haldon, V., Brown, L., & Henry, L. (2002). A pragmatic tool for the measurement of perineal tears. British Journal of Midwifery, 10(7), 412-417. https://doi.org/10.12968/bjom.2002.10.7.10582 Go to original source...
    18. Nager, C. W., & Helliwell, J. P. (2001). Episiotomy increases perineal laceration length in primiparous women. American Journal of Obstetrics and Gynecology, 185(2), 444-450. https://doi.org/10.1067/mob.2001.116095 Go to original source... Go to PubMed...
    19. National Institute for Health and Care Excellence. (2014, December). Intrapartum care: care of healthy women and babies: clinical guideline [CG190]. https://www.nice.org.uk/guidance/cg190
    20. National Health Service (NHS) Digital. (2019, October). NHS maternity statistics, England 2018-19 [PAS]. NHS maternity statistics. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2018-19
    21. Riesco, M. L., & Oliveira, S. M. (2007). Avaliação do edema perineal no pós-parto: concordância entre observadores [Postnatal perineal edema assessment: agreement among observers]. Revista Gaucha de Enfermagem, 28(4), 465-472. Go to PubMed...
    22. Royal College of Obstetricians and Gynaecologists. (2015, June). The management of third- and fourth-degree perineal tears. Green-top Guideline No. 29. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-29.pdf
    23. Samuelsson, E., Ladfors, L., Lindblom, B. G., & Hagberg, H. (2002). A prospective observational study on tears during vaginal delivery: occurrences and risk factors. Acta Obstetricia et Gynecologica Scandinavica, 81(1), 44-49. https://doi.org/10.1046/j.0001-6349.2001.10182.x Go to original source... Go to PubMed...
    24. Silva, F. M., Oliveira, S. M., Bick, D., Osava, R. H., Tuesta, E. F., & Riesco, M. L. (2012). Risk factors for birth-related perineal trauma: a cross-sectional study in a birth centre. Journal of Clinical Nursing, 21(15-16), 2209-2218. https://doi.org/10.1111/j.1365-2702.2012.04133.x Go to original source... Go to PubMed...
    25. Smith, L. A., Price, N., Simonite, V., & Burns, E. E. (2013). Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy and Childbirth, 13, 59. https://doi.org/10.1186/1471-2393-13-59 Go to original source... Go to PubMed...
    26. Sultan, A. H. (1999). Editorial: Obstetrical perineal injury and anal incontinence. AVMA Medical & Legal Journal, 5(6), 193-196. https://doi.org/10.1177/135626229900500601 Go to original source...
    27. Tohill, S., & Kettle, C. (2011). Perineal care. BMJ Clinical Evidence, 2011, 1401.
    28. Verghese, T. S., Champaneria, R., Kapoor, D. S., & Latthe, P. M. (2016). Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis. International Urogynecology Journal, 27, 1459-1467. https://doi.org/10.1007/s00192-016-2956-1 Go to original source... Go to PubMed...
    29. Wiseman, O., Rafferty, A. M., Stockley, J., Murrells, T., & Bick, D. (2019). Infection and wound breakdown in spontaneous second-degree perineal tears: an exploratory mixed methods study. Birth, 46(1), 80-89. https://doi.org/10.1111/birt.12389 Go to original source... Go to PubMed...
    30. Yildirim, G., & Beji, N. K. (2008). Effects of pushing techniques in birth on mother and fetus: a randomized study. Birth, 35(1), 25-30. https://doi.org/10.1111/j.1523-536X.2007.00208.x Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content