Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Severe perineal laceration during operative vaginal delivery: the impact of occiput posterior position

Journal of Perinatology volume 34, pages 898–900 (2014)Cite this article

Subjects

Abstract

Objective:

To identify risk factors for severe (third/fourth degree) perineal laceration with operative vaginal delivery (OVD, forceps or vacuum).

Study Design:

Case-control study comparing singleton OVDs with or without severe laceration (n=138).

Result:

In multivariable analyses, severe perineal laceration was associated with occiput posterior (OP) position at delivery, vaginal nulliparity, use of forceps, longer period pushing in the second stage and lower gestational age, but not birth weight, labor induction or episiotomy. Among 29 OP patients at full dilation, 9/13 (69%) attempted rotations to occiput anterior (OA) were successful, and 14/16 (88%) patients in whom rotation was not attempted remained OP at delivery. Successful rotation from OP to OA was associated with fewer severe lacerations than no attempt or unsuccessful rotation (22 vs 75%, P=0.01).

Conclusion:

Severe perineal laceration during OVD is associated with OP position at delivery and is reduced threefold in patients successfully rotated from OP to OA.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Hordnes K, Bergsjo P . Severe lacerations after childbirth. Acta Obstet Gynecol Scand 1993; 72 (6): 413–422.

    Article  CAS  Google Scholar 

  2. Borello-France D, Burgio KL, Richter HE, Zyczynski H, Fitzgerald MP, Whitehead W et al. Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 2006; 108 (4): 863–872.

    Article  Google Scholar 

  3. Bofill JA, Rust OA, Schorr SJ, Brown RC, Martin RW, Martin JN Jr et al. A randomized prospective trial of the obstetric forceps versus the M-cup vacuum extractor. Am J Obstet Gynecol. 1996; 175 (5): 1325–1330.

    Article  CAS  Google Scholar 

  4. Caughey AB, Sandberg PL, Zlatnik MG, Thiet MP, Parer JT, Laros RK Jr . Forceps compared with vacuum: rates of neonatal and maternal morbidity. Obstet Gynecol. 2005; 106 (5 Pt 1): 908–912.

    Article  Google Scholar 

  5. Damron DP, Capeless EL . Operative vaginal delivery: a comparison of forceps and vacuum for success rate and risk of rectal sphincter injury. Am J Obstet Gynecol. 2004; 191 (3): 907–910.

    Article  Google Scholar 

  6. Dandolu V, Chatwani A, Harmanli O, Floro C, Gaughan JP, Hernandez E . Risk factors for obstetrical anal sphincter lacerations. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16 (4): 304–307.

    Article  Google Scholar 

  7. Landy HJ, Laughon SK, Bailit JL, Kominiarek MA, Gonzalez-Quintero VH, Ramirez M et al. Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. Obstet Gynecol 2011; 117 (3): 627–635.

    Article  Google Scholar 

  8. Benavides L, Wu JM, Hundley AF, Ivester TS, Visco AG . The impact of occiput posterior fetal head position on the risk of anal sphincter injury in forceps-assisted vaginal deliveries. Am J Obstet Gynecol. 2005; 192 (5): 1702–1706.

    Article  Google Scholar 

  9. Senecal J, Xiong X, Fraser WD . Effect of fetal position on second-stage duration and labor outcome. Obstet Gynecol 2005; 105 (4): 763–772.

    Article  Google Scholar 

  10. Wu JM, Williams KS, Hundley AF, Connolly A, Visco AG . Occiput posterior fetal head position increases the risk of anal sphincter injury in vacuum-assisted deliveries. Am J Obstet Gynecol. 2005; 193 (2) 525–528.

    Article  Google Scholar 

  11. Bradley MS, Kaminski RJ, Streitman DC, Dunn SL, Krans EE . Effect of rotation on perineal lacerations in forceps-assisted vaginal deliveries. Obstet Gynecol 2013; 122 (1): 132–137.

    Article  Google Scholar 

  12. Hankins GD, Leicht T, Van Hook J, Uckan EM . The role of forceps rotation in maternal and neonatal injury. Am J Obstet Gynecol 1999; 180 (1 Pt 1): 231–234.

    Article  CAS  Google Scholar 

  13. Le Ray C, Deneux-Tharaux C, Khireddine I, Dreyfus M, Vardon D, Goffinet F . Manual rotation to decrease operative delivery in posterior or transverse positions. Obstet Gynecol 2013; 122 (3): 634–640.

    Article  Google Scholar 

  14. Le Ray C, Serres P, Schmitz T, Cabrol D, Goffinet F . Manual rotation in occiput posterior or transverse positions: risk factors and consequences on the cesarean delivery rate. Obstet Gynecol 2007; 110 (4): 873–879.

    Article  Google Scholar 

  15. Reichman O, Gdansky E, Latinsky B, Labi S, Samueloff A . Digital rotation from occipito-posterior to occipito-anterior decreases the need for cesarean section. Eur J Obstet Gynecol Reprod Biol 2008; 136 (1): 25–28.

    Article  Google Scholar 

  16. Shaffer BL, Cheng YW, Vargas JE, Caughey AB . Manual rotation to reduce caesarean delivery in persistent occiput posterior or transverse position. J Matern Fetal Neonatal Med 2011; 24 (1): 65–72.

    Article  Google Scholar 

  17. Stock SJ, Josephs K, Farquharson S, Love C, Cooper SE, Kissack C et al. Maternal and neonatal outcomes of successful Kielland's rotational forceps delivery. Obstet Gynecol 2013; 121 (5): 1032–1039.

    Article  Google Scholar 

  18. Norwitz ER Robinson JN Repke JT . Labor and delivery. In: Gabbe SG, Niebyl JR, Simpson JL (eds). Obstetrics: Normal and Problem Pregnancies. Philadelphia, PA, USA: Churchill Lovingstone, 2002, pp 353–394.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA

    E Hirsch, R Elue, A Wagner Jr, K Nelson, R K Silver, Y Zhou & M G Adams

  2. Department of Obstetrics and Gynecology, The University of Chicago, Chicago,, IL, USA

    E Hirsch, A Wagner Jr, K Nelson, R K Silver & Y Zhou

Authors
  1. E Hirsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R Elue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Wagner Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R K Silver
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M G Adams
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E Hirsch.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirsch, E., Elue, R., Wagner, A. et al. Severe perineal laceration during operative vaginal delivery: the impact of occiput posterior position. J Perinatol 34, 898–900 (2014). https://doi.org/10.1038/jp.2014.103

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2014.103

This article is cited by

Search

Advanced search

Quick links