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.

Klíčová slova: lacerations, midwifery, obstetrics, parturition, perineum

Vloženo: 7. červenec 2020; Revidováno: 24. listopad 2020; Přijato: 31. prosinec 2020; Zveřejněno: 5. březen 2021  Zobrazit citaci

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.
Sdílet...
Stáhnout citaci
  • 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)
    • Zobrazit celý článek

    Reference

    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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji...
    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 Přejít k původnímu zdroji... Přejít na 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. Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji...
    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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na 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 Přejít k původnímu zdroji... Přejít na PubMed...

    Tento článek je publikován v režimu tzv. otevřeného přístupu k vědeckým informacím (Open Access), který je distribuován pod licencí Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), která umožňuje nekomerční distribuci, reprodukci a změny, pokud je původní dílo řádně ocitováno. Není povolena distribuce, reprodukce nebo změna, která není v souladu s podmínkami této licence.


    Zpět na obsah