Characteristics associated with severe perineal and cervical lacerations during vaginal delivery

Helain J. Landy, S. Katherine Laughon, Jennifer L. Bailit, Michelle A. Kominiarek, Victor Hugo Gonzalez-Quintero, Mildred Ramirez, Shoshana Haberman, Judith Hibbard, Isabelle Wilkins, D. Ware Branch, Ronald T. Burkman, Kimberly Gregory, Matthew K. Hoffman, Lee A. Learman, Christos Hatjis, Paul C. Vanveldhuisen, Uma M. Reddy, James Troendle, Liping Sun, Jun Zhang

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

OBJECTIVE: To characterize potentially modifiable risk factors for third- or fourth-degree perineal lacerations and cervical lacerations in a contemporary U.S. obstetric practice. METHODS: The Consortium on Safe Labor collected electronic medical records from 19 hospitals within 12 institutions (228,668 deliveries from 2002 to 2008). Information on patient characteristics, prenatal complications, labor and delivery data, and maternal and neonatal outcomes were collected. Only women with successful vaginal deliveries of cephalic singletons at 34 weeks of gestation or later were included; we excluded data from sites lacking information about lacerations at delivery and deliveries complicated by shoulder dystocia; 87,267 and 71,170 women were analyzed for third- or fourth-degree and cervical lacerations, respectively. Multivariable logistic regressions were used to adjust for other factors. RESULTS: Third- or fourth-degree lacerations occurred in 2,516 women (2,223 nulliparous [5.8%], 293 [0.6%] multiparous) and cervical lacerations occurred in 536 women (324 nulliparous [1.1%], 212 multiparous [0.5%]). Risks for third- or fourth-degree lacerations included nulliparity (7.2-fold risk), being Asian or Pacific Islander, increasing birth weight, operative vaginal delivery, episiotomy, and longer second stage of labor. Increasing body mass index was associated with fewer lacerations. Risk factors for cervical lacerations included young maternal age, vacuum vaginal delivery, and oxytocin use among multiparous women, and cerclage regardless of parity. CONCLUSION: Our large cohort of women with severe obstetric lacerations reflects contemporary obstetric practices. Nulliparity and episiotomy use are important risk factors for third- or fourth-degree lacerations. Cerclage increases the risk for cervical lacerations. Many identified risk factors may not be modifiable.

Original languageEnglish (US)
Pages (from-to)627-635
Number of pages9
JournalObstetrics and gynecology
Volume117
Issue number3
DOIs
StatePublished - Mar 1 2011

Fingerprint

Lacerations
Parity
Episiotomy
Obstetrics
Obstetric Labor Complications
Second Labor Stage
Dystocia
Electronic Health Records
Maternal Age
Oxytocin
Vacuum
Birth Weight
Body Mass Index
Logistic Models
Head
Mothers

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Landy, H. J., Laughon, S. K., Bailit, J. L., Kominiarek, M. A., Gonzalez-Quintero, V. H., Ramirez, M., ... Zhang, J. (2011). Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. Obstetrics and gynecology, 117(3), 627-635. https://doi.org/10.1097/AOG.0b013e31820afaf2
Landy, Helain J. ; Laughon, S. Katherine ; Bailit, Jennifer L. ; Kominiarek, Michelle A. ; Gonzalez-Quintero, Victor Hugo ; Ramirez, Mildred ; Haberman, Shoshana ; Hibbard, Judith ; Wilkins, Isabelle ; Branch, D. Ware ; Burkman, Ronald T. ; Gregory, Kimberly ; Hoffman, Matthew K. ; Learman, Lee A. ; Hatjis, Christos ; Vanveldhuisen, Paul C. ; Reddy, Uma M. ; Troendle, James ; Sun, Liping ; Zhang, Jun. / Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. In: Obstetrics and gynecology. 2011 ; Vol. 117, No. 3. pp. 627-635.
@article{21b2490a8e7e447da32c04823fb4ab65,
title = "Characteristics associated with severe perineal and cervical lacerations during vaginal delivery",
abstract = "OBJECTIVE: To characterize potentially modifiable risk factors for third- or fourth-degree perineal lacerations and cervical lacerations in a contemporary U.S. obstetric practice. METHODS: The Consortium on Safe Labor collected electronic medical records from 19 hospitals within 12 institutions (228,668 deliveries from 2002 to 2008). Information on patient characteristics, prenatal complications, labor and delivery data, and maternal and neonatal outcomes were collected. Only women with successful vaginal deliveries of cephalic singletons at 34 weeks of gestation or later were included; we excluded data from sites lacking information about lacerations at delivery and deliveries complicated by shoulder dystocia; 87,267 and 71,170 women were analyzed for third- or fourth-degree and cervical lacerations, respectively. Multivariable logistic regressions were used to adjust for other factors. RESULTS: Third- or fourth-degree lacerations occurred in 2,516 women (2,223 nulliparous [5.8{\%}], 293 [0.6{\%}] multiparous) and cervical lacerations occurred in 536 women (324 nulliparous [1.1{\%}], 212 multiparous [0.5{\%}]). Risks for third- or fourth-degree lacerations included nulliparity (7.2-fold risk), being Asian or Pacific Islander, increasing birth weight, operative vaginal delivery, episiotomy, and longer second stage of labor. Increasing body mass index was associated with fewer lacerations. Risk factors for cervical lacerations included young maternal age, vacuum vaginal delivery, and oxytocin use among multiparous women, and cerclage regardless of parity. CONCLUSION: Our large cohort of women with severe obstetric lacerations reflects contemporary obstetric practices. Nulliparity and episiotomy use are important risk factors for third- or fourth-degree lacerations. Cerclage increases the risk for cervical lacerations. Many identified risk factors may not be modifiable.",
author = "Landy, {Helain J.} and Laughon, {S. Katherine} and Bailit, {Jennifer L.} and Kominiarek, {Michelle A.} and Gonzalez-Quintero, {Victor Hugo} and Mildred Ramirez and Shoshana Haberman and Judith Hibbard and Isabelle Wilkins and Branch, {D. Ware} and Burkman, {Ronald T.} and Kimberly Gregory and Hoffman, {Matthew K.} and Learman, {Lee A.} and Christos Hatjis and Vanveldhuisen, {Paul C.} and Reddy, {Uma M.} and James Troendle and Liping Sun and Jun Zhang",
year = "2011",
month = "3",
day = "1",
doi = "10.1097/AOG.0b013e31820afaf2",
language = "English (US)",
volume = "117",
pages = "627--635",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

Landy, HJ, Laughon, SK, Bailit, JL, Kominiarek, MA, Gonzalez-Quintero, VH, Ramirez, M, Haberman, S, Hibbard, J, Wilkins, I, Branch, DW, Burkman, RT, Gregory, K, Hoffman, MK, Learman, LA, Hatjis, C, Vanveldhuisen, PC, Reddy, UM, Troendle, J, Sun, L & Zhang, J 2011, 'Characteristics associated with severe perineal and cervical lacerations during vaginal delivery', Obstetrics and gynecology, vol. 117, no. 3, pp. 627-635. https://doi.org/10.1097/AOG.0b013e31820afaf2

Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. / Landy, Helain J.; Laughon, S. Katherine; Bailit, Jennifer L.; Kominiarek, Michelle A.; Gonzalez-Quintero, Victor Hugo; Ramirez, Mildred; Haberman, Shoshana; Hibbard, Judith; Wilkins, Isabelle; Branch, D. Ware; Burkman, Ronald T.; Gregory, Kimberly; Hoffman, Matthew K.; Learman, Lee A.; Hatjis, Christos; Vanveldhuisen, Paul C.; Reddy, Uma M.; Troendle, James; Sun, Liping; Zhang, Jun.

In: Obstetrics and gynecology, Vol. 117, No. 3, 01.03.2011, p. 627-635.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Characteristics associated with severe perineal and cervical lacerations during vaginal delivery

AU - Landy, Helain J.

AU - Laughon, S. Katherine

AU - Bailit, Jennifer L.

AU - Kominiarek, Michelle A.

AU - Gonzalez-Quintero, Victor Hugo

AU - Ramirez, Mildred

AU - Haberman, Shoshana

AU - Hibbard, Judith

AU - Wilkins, Isabelle

AU - Branch, D. Ware

AU - Burkman, Ronald T.

AU - Gregory, Kimberly

AU - Hoffman, Matthew K.

AU - Learman, Lee A.

AU - Hatjis, Christos

AU - Vanveldhuisen, Paul C.

AU - Reddy, Uma M.

AU - Troendle, James

AU - Sun, Liping

AU - Zhang, Jun

PY - 2011/3/1

Y1 - 2011/3/1

N2 - OBJECTIVE: To characterize potentially modifiable risk factors for third- or fourth-degree perineal lacerations and cervical lacerations in a contemporary U.S. obstetric practice. METHODS: The Consortium on Safe Labor collected electronic medical records from 19 hospitals within 12 institutions (228,668 deliveries from 2002 to 2008). Information on patient characteristics, prenatal complications, labor and delivery data, and maternal and neonatal outcomes were collected. Only women with successful vaginal deliveries of cephalic singletons at 34 weeks of gestation or later were included; we excluded data from sites lacking information about lacerations at delivery and deliveries complicated by shoulder dystocia; 87,267 and 71,170 women were analyzed for third- or fourth-degree and cervical lacerations, respectively. Multivariable logistic regressions were used to adjust for other factors. RESULTS: Third- or fourth-degree lacerations occurred in 2,516 women (2,223 nulliparous [5.8%], 293 [0.6%] multiparous) and cervical lacerations occurred in 536 women (324 nulliparous [1.1%], 212 multiparous [0.5%]). Risks for third- or fourth-degree lacerations included nulliparity (7.2-fold risk), being Asian or Pacific Islander, increasing birth weight, operative vaginal delivery, episiotomy, and longer second stage of labor. Increasing body mass index was associated with fewer lacerations. Risk factors for cervical lacerations included young maternal age, vacuum vaginal delivery, and oxytocin use among multiparous women, and cerclage regardless of parity. CONCLUSION: Our large cohort of women with severe obstetric lacerations reflects contemporary obstetric practices. Nulliparity and episiotomy use are important risk factors for third- or fourth-degree lacerations. Cerclage increases the risk for cervical lacerations. Many identified risk factors may not be modifiable.

AB - OBJECTIVE: To characterize potentially modifiable risk factors for third- or fourth-degree perineal lacerations and cervical lacerations in a contemporary U.S. obstetric practice. METHODS: The Consortium on Safe Labor collected electronic medical records from 19 hospitals within 12 institutions (228,668 deliveries from 2002 to 2008). Information on patient characteristics, prenatal complications, labor and delivery data, and maternal and neonatal outcomes were collected. Only women with successful vaginal deliveries of cephalic singletons at 34 weeks of gestation or later were included; we excluded data from sites lacking information about lacerations at delivery and deliveries complicated by shoulder dystocia; 87,267 and 71,170 women were analyzed for third- or fourth-degree and cervical lacerations, respectively. Multivariable logistic regressions were used to adjust for other factors. RESULTS: Third- or fourth-degree lacerations occurred in 2,516 women (2,223 nulliparous [5.8%], 293 [0.6%] multiparous) and cervical lacerations occurred in 536 women (324 nulliparous [1.1%], 212 multiparous [0.5%]). Risks for third- or fourth-degree lacerations included nulliparity (7.2-fold risk), being Asian or Pacific Islander, increasing birth weight, operative vaginal delivery, episiotomy, and longer second stage of labor. Increasing body mass index was associated with fewer lacerations. Risk factors for cervical lacerations included young maternal age, vacuum vaginal delivery, and oxytocin use among multiparous women, and cerclage regardless of parity. CONCLUSION: Our large cohort of women with severe obstetric lacerations reflects contemporary obstetric practices. Nulliparity and episiotomy use are important risk factors for third- or fourth-degree lacerations. Cerclage increases the risk for cervical lacerations. Many identified risk factors may not be modifiable.

UR - http://www.scopus.com/inward/record.url?scp=79952036135&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952036135&partnerID=8YFLogxK

U2 - 10.1097/AOG.0b013e31820afaf2

DO - 10.1097/AOG.0b013e31820afaf2

M3 - Article

C2 - 21343766

AN - SCOPUS:79952036135

VL - 117

SP - 627

EP - 635

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 3

ER -