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Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study

BACKGROUND: We sought to investigate the impact of the duration of second stage of labor on risk of severe perineal lacerations (third and fourth degree). METHODS: This population based cohort study was conducted in the Stockholm/Gotland region, Sweden, 2008–2014. Study population included 52 211 pr...

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Autores principales: Simic, Marija, Cnattingius, Sven, Petersson, Gunnar, Sandström, Anna, Stephansson, Olof
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5320686/
https://www.ncbi.nlm.nih.gov/pubmed/28222704
http://dx.doi.org/10.1186/s12884-017-1251-6
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author Simic, Marija
Cnattingius, Sven
Petersson, Gunnar
Sandström, Anna
Stephansson, Olof
author_facet Simic, Marija
Cnattingius, Sven
Petersson, Gunnar
Sandström, Anna
Stephansson, Olof
author_sort Simic, Marija
collection PubMed
description BACKGROUND: We sought to investigate the impact of the duration of second stage of labor on risk of severe perineal lacerations (third and fourth degree). METHODS: This population based cohort study was conducted in the Stockholm/Gotland region, Sweden, 2008–2014. Study population included 52 211 primiparous women undergoing vaginal delivery with cephalic presentation at term. Unconditional logistic regression analysis was used to calculate crude and adjusted odds ratios (OR), using 95% confidence intervals (CI). Main exposure was duration of second stage of labor, and main outcome was risks of severe perineal lacerations (third and fourth degree). RESULTS: Risk of severe perineal lacerations increased with duration of second stage of labor. Compared with a second stage of labor of 1 h or less, women with a second stage of more than 2 h had an increased risk (aOR 1.42; 95% CI 1.28–1.58). Compared with non-instrumental vaginal deliveries, the risk was elevated among instrumental vaginal deliveries (aOR 2.24; 95% CI 2.07–2.42). The risk of perineal laceration increased with duration of second stage of labor until less than 3 h in both instrumental and non-instrumental vaginal deliveries, but after 3 h, the ORs did not further increase. After adjustments for potential confounders, macrosomia (birth weight > 4 500 g) and occiput posterior fetal position were risk factors of severe perineal lacerations. CONCLUSIONS: The risk of severe perineal laceration increases with duration until the third hour of second stage of labor. Instrumental delivery is the most significant risk factor for severe lacerations, followed by duration of second stage of labor, fetal size and occiput posterior fetal position.
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spelling pubmed-53206862017-02-24 Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study Simic, Marija Cnattingius, Sven Petersson, Gunnar Sandström, Anna Stephansson, Olof BMC Pregnancy Childbirth Research Article BACKGROUND: We sought to investigate the impact of the duration of second stage of labor on risk of severe perineal lacerations (third and fourth degree). METHODS: This population based cohort study was conducted in the Stockholm/Gotland region, Sweden, 2008–2014. Study population included 52 211 primiparous women undergoing vaginal delivery with cephalic presentation at term. Unconditional logistic regression analysis was used to calculate crude and adjusted odds ratios (OR), using 95% confidence intervals (CI). Main exposure was duration of second stage of labor, and main outcome was risks of severe perineal lacerations (third and fourth degree). RESULTS: Risk of severe perineal lacerations increased with duration of second stage of labor. Compared with a second stage of labor of 1 h or less, women with a second stage of more than 2 h had an increased risk (aOR 1.42; 95% CI 1.28–1.58). Compared with non-instrumental vaginal deliveries, the risk was elevated among instrumental vaginal deliveries (aOR 2.24; 95% CI 2.07–2.42). The risk of perineal laceration increased with duration of second stage of labor until less than 3 h in both instrumental and non-instrumental vaginal deliveries, but after 3 h, the ORs did not further increase. After adjustments for potential confounders, macrosomia (birth weight > 4 500 g) and occiput posterior fetal position were risk factors of severe perineal lacerations. CONCLUSIONS: The risk of severe perineal laceration increases with duration until the third hour of second stage of labor. Instrumental delivery is the most significant risk factor for severe lacerations, followed by duration of second stage of labor, fetal size and occiput posterior fetal position. BioMed Central 2017-02-21 /pmc/articles/PMC5320686/ /pubmed/28222704 http://dx.doi.org/10.1186/s12884-017-1251-6 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Simic, Marija
Cnattingius, Sven
Petersson, Gunnar
Sandström, Anna
Stephansson, Olof
Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study
title Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study
title_full Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study
title_fullStr Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study
title_full_unstemmed Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study
title_short Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study
title_sort duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5320686/
https://www.ncbi.nlm.nih.gov/pubmed/28222704
http://dx.doi.org/10.1186/s12884-017-1251-6
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