Breakdown of Perineal Laceration Repair After Vaginal Delivery: A Case-Control Study. Issue 4 (July 2016)

• Record Type: Journal Article
• Authors: Jallad, Karl; Steele, Sarah E.; Barber, Matthew D.
• Is Part Of: Female pelvic medicine & reconstructive surgery. Volume 22:Issue 4(2016:Jul./Aug.)
• Publication Date: 2016-07
• Subjects: breakdown of perineal laceration -- episiotomy -- operative delivery -- midwife -- chromic suture; Pelvis -- Diseases -- Periodicals; Pelvis -- Surgery -- Periodicals; Genital Diseases, Female -- surgery -- Periodicals; Urologic Diseases -- surgery -- Periodicals; Colonic Diseases -- surgery -- Periodicals; Rectal Diseases -- surgery -- Periodicals; Surgical Procedures, Operative -- methods -- Periodicals; 616.6
• DOI: 10.1097/SPV.0000000000000274
• Languages: English
• ISSNs: 2151-8378

Abstract

Abstract : Objective: The aim of the study was to estimate risk factors associated with breakdown of perineal laceration repair after vaginal delivery. Methods: This is a case-control study of women who sustained a breakdown of perineal laceration repair after vaginal delivery between 2002 and 2015. Cases were patients who sustained a perineal wound breakdown after vaginal delivery and repair of a second-, third-, or fourth-degree laceration. Controls, matched 1:1, were patients who either sustained a second-, third-, or fourth-degree perineal laceration and repair without evidence of breakdown and who delivered on the same day and institution as the case. Results: A total of 104, 301 deliveries were assessed for breakdown of perineal laceration. One hundred forty-four met the inclusion criteria. These were matched with 144 controls. Logistic regression analysis demonstrated that smoking is associated with increased risk for breakdown of perineal laceration (adjusted odds ratio [adj. OR], 6.4; 95% confidence interval [CI], 1.2–38.5), whereas a previous vaginal delivery is protective (adj. OR, 0.14; 95% CI, 0.05-0.3). In addition, third- or fourth-degree laceration (adj. OR, 4.0; 95% CI, 1.1–15.7), presence of episiotomy at time of delivery (adj. OR, 11.1; 95% CI, 2.9–48.8), operative delivery (adj. OR, 3.4; 95% CI, 1.2–10.3), midwife performing the laceration repair (adj. OR, 4.7; 95% CI, 1.5–15.8), and use of chromic suture (adj. OR, 3.9; 95% CI, 1.6–9.8) were independent risk factors for breakdown of perineal laceration. Conclusions: Smoking, nulliparity, episiotomy, operative delivery, third- or fourth-degree laceration, repair by a midwife, and use of chromic suture are independent risk factors for breakdown of perineal laceration repair after vaginal delivery. Abstract : Smoking, nulliparity, episiotomy, operative delivery, third- or fourth-degree laceration, repair by a midwife, and use of chromic suture are risk factors for breakdown of perineal laceration repair.