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Risk factors for poor perineal outcome after operative vaginal delivery

Journal of Perinatology volume 38, pages 1625–1630 (2018)Cite this article

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Abstract

Objective

Identify risk factors for poor perineal outcome after operative vaginal delivery.

Study design

A retrospective cohort study was performed including operative vaginal deliveries during 2015 through 2016.

Results

Of 529 operative vaginal deliveries, 79 (14.9%) had higher order perineal lacerations and 14 (2.7%) had a wound breakdown. The only significant risk factor for higher order lacerations was chorioamnionitis (aOR 2.2; 95% CI 1.09–4.44). Risk factors for perineal wound breakdown included episiotomy (5.2 vs. 1.2%; p < 0.01), type of operative delivery (5.5% after forceps vs. 1.4% after vacuum; p < 0.01) and postpartum narcotic use. Overall, 9.3% of those using narcotics subsequently had a perineal breakdown as compared to 0.7% (p < 0.01). Narcotic use postpartum remained strongly associated in multivariable logistic regression (aOR 21.29; 95% CI 5.43–83.47). Patients with forceps deliveries, episiotomy, and narcotic use had a 38% risk of breakdown.

Conclusion

Women at highest risk of perineal wound breakdown benefit from close follow-up.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Gianna L. Wilkie, Michael Saadeh, Julian N. Robinson & Sarah E. Little

Authors
  1. Gianna L. Wilkie
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  2. Michael Saadeh
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  3. Julian N. Robinson
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  4. Sarah E. Little
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Corresponding author

Correspondence to Gianna L. Wilkie.

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The authors declare that they have no conflict of interest.

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Wilkie, G.L., Saadeh, M., Robinson, J.N. et al. Risk factors for poor perineal outcome after operative vaginal delivery. J Perinatol 38, 1625–1630 (2018). https://doi.org/10.1038/s41372-018-0252-2

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  • DOI: https://doi.org/10.1038/s41372-018-0252-2

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