Risk Factors For Perineal Injury: A Systematic Review

Abstract

Several studies have investigated the importance of maternal, fetal factors and intrapartum characteristics in predicting severe perineal lacerations. The purpose of the present systematic review is to evaluate on research regarding risk factors for perineal injury. We reviewed PubMed, Science-Direct, Cochrane Library, and Medline for published studies in the field for observational studies. Two researchers independently assessed the included studies and documented outcomes. Data extraction was performed using a modified data form. Twenty-nine articles were selected for inclusion in the present systematic review. Several factors contribute to the development of severe perineal injury. The most common risk factor investigated was parity, episiotomy, birth weight, maternal age, prolonged 2nd stage of labor, head circumference, and instrumental deliveries. The present systematic review presents accumulated data that may help birth attendant estimate risks and provide appropriate intervention.

References

1. 1.Organization WH. Standards for improving quality of maternal and newborn care in health facilities. 2016;
2. 2.2. Blondel B, Alexander S, Bjarnadóttir RI, Gissler M, Langhoff-Roos J, Novak-Antolič Ž, et al. Variations in rates of severe perineal tears and episiotomies in 20 European countries: a study based on routine national data in Euro-Peristat Project. Acta obstetricia et gynecologica Scandinavica. 2016;95(7):746–54.
3. 3.Sinclair AJ, Ramsay IN. The psychosocial impact of urinary incontinence in women. The Obstetrician & Gynaecologist. 2011;13(3):143–8. 162 GC, Vidarte MFE, et al. FIGO position paper: how to stop the caesarean section epidemic. The Lancet. 2018;392(10155):1286–7.
4. 4.Cichowski S, Rogers R. Prevention and Management of Obstetric Lacerations at Vaginal Delivery. OBSTETRICS AND GYNECOLOGY. 2018;132(3):E87–102.
5. 5.Lawrence L, Rebecca R, Noelle B, Dusty T, Clifford Q. The effect of perineal lacerations on pelvic floor function and anatomy at six months postpartum in a prospective cohort of nulliparous women. Birth (Berkeley, Calif). 2016;43(4):293.
6. 6.Tsakiridis I, Mamopoulos A, Athanasiadis A, Dagklis T. Obstetric anal sphincter injuries at vaginal delivery: Risk Factors For Perineal Injury: A Systematic Review Majmaah Journal of Health Sciences ,Vol. 12, Issue 3 , July - 2024, Dhu Al-Hijjah - 1445 a review of recently published national 16. Bugti Z, Ahsan N, Salam R, Naeem guidelines. Obstetrical & gynecologi- S, Shoaib M. Factors Leading to Percal survey. 2018;73(12):695–702. ineal Tear During Vaginal Delivery.
7. 7.Pergialiotis V, Vlachos D, Protopapas National Editorial Advisory Board. A, Pappa K, Vlachos G. Risk factors for 2019;30(11):73. severe perineal lacerations during child- 17. Bączek G, Rzońca E, Sys D, Rychlebirth. International Journal of Gynecolwicz S, Durka A, Rzońca P, et al. ogy & Obstetrics. 2014;125(1):6–14. Spontaneous perineal trauma during
8. 8.Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International Journal of Surgery. 2021;88:105906.
9. 9.Higgins J, Morgan R, Rooney A, Taylor K, Thayer K, Silva R, et al. Risk Of Bias In Non-randomized Studies-of Exposure (ROBINS-E): Launch version. Risk Of Bias. 2022;
10. 10.Komorowski LK, Leeman LM, Fullilove AM, Bedrick EJ, Migliaccio LD, Rogers RG. Does a large infant head or a short perineal body increase the risk non-operative childbirth—retrospective analysis of perineal laceration risk factors. International Journal of Environmental Research and Public Health. 2022;19(13):7653.
11. 11.Christianson L, Bovbjerg V, McDavitt E, Hullfish K. Risk factors for perineal injury during delivery. American journal of obstetrics and gynecology. 2003 Jul 1;189:255–60.
12. 12.Dahlen HG, Ryan M, Homer CSE, Cooke M. An Australian prospective cohort study of risk factors for severe perineal trauma during childbirth. Midwifery. 2007;23(2):196–203. of obstetrical perineal trauma? Birth. 20. Dahlen H, Priddis H, Schmied V, Sneddon A, Kettle C, Brown C, et al. Trends 2014;41(2):147–52.
13. 13.dos Santos RV, Pereira ARR, de Paiva Lima CRO, de Sousa Dantas D, Ferreira CWS. Perineal trauma in nulliparous women and its associated factors. ABCS Health Sciences. 2021;46:e021224–e021224. and risk factors for severe perineal trauma during childbirth in New South Wales between 2000 and 2008: a population-based data study. BMJ open. 2013;3(5):e002824.
14. 14.Eskandar O, Shet D. Risk factors for Risk Factors For Perineal Injury: A Systematic Review 163 Majmaah Journal of Health Sciences ,Vol. 12, Issue 3 , July - 2024, Dhu Al-Hijjah - 1445 3rd and 4th degree perineal tear. Jour- Grinstein E, Bar J, Kovo M, et al. The nal of Obstetrics and Gynaecology. association between the number of 2009;29(2):119–22. vaginal examinations during labor and
15. 15.Fodstad K, Staff AC, Laine K. Sexual activity and dyspareunia the first year postpartum in relation to degree of perperineal trauma: a retrospective cohort study. Archives of Gynecology and Obstetrics. 2020;301:1405–10. ineal trauma. International urogynecol- 28. Hsieh W-C, Liang C-C, Wu D, Chang ogy journal. 2016;27:1513–23.
16. 16.Hauck YL, Lewis L, Nathan EA, White C, Doherty DA. Risk factors for severe perineal trauma during vaginal childbirth: a Western Australian retrospective cohort study. Women and Birth. S-D, Chueh H-Y, Chao A-S. Prevalence and contributing factors of severe perineal damage following episiotomy-assisted vaginal delivery. Taiwanese Journal of Obstetrics and Gynecology. 2014;53(4):481–5.
17. 17.Kudish B, Sokol RJ, Kruger M. Trends 2015;28(1):16–20.
18. 18.Vale de Castro Monteiro M, Pereira GMV, Aguiar RAP, Azevedo RL, Correia-Junior MD, Reis ZSN. Risk factors for severe obstetric perineal lacin major modifiable risk factors for severe perineal trauma, 1996–2006. International Journal of Gynecology & Obstetrics. 2008;102(2):165–70. erations. International urogynecology 30. Kituku J, Getanda A, Mwangi A. Prevalence and risk factors for perineal journal. 2016;27:61–7.
19. 19.Albers LL, Anderson D, Cragin L, Daniels SM, Hunter C, Sedler KD, et trauma among women at a Teaching and Referral Hospital in Kenya. 2019; al. Factors related to perineal trauma in 31. D’Souza JC, Monga A, Tincello DG. childbirth. Journal of Nurse-Midwife- Risk factors for perineal trauma in the ry. 1996;41(4):269–76. primiparous population during non-op-
20. 20.Enyindah CE, Fiebai PO, Anya SE, Okpani AO. Episiotomy and perineal trauerative vaginal delivery. International urogynecology journal. 2020;31:621–5. ma prevalence and obstetric risk fac- 32. Gommesen D, Nohr EA, Drue HC, tors in Port Harcourt, Nigeria. Nigerian Qvist N, Rasch V. Obstetric perineal Journal of medicine. 2007;16(3):242–5. tears: risk factors, wound infection and
21. 21.Gluck O, Ganer Herman H, Tal O, dehiscence: a prospective cohort study. 164 Risk Factors For Perineal Injury: A Systematic Review Majmaah Journal of Health Sciences ,Vol. 12, Issue 3 , July - 2024, Dhu Al-Hijjah - 1445 Archives of gynecology and obstetrics. birth centre. Journal of clinical nursing. 2019;300:67–77. 2012;21(15-16):2209–18.
22. 22.Groutz A, Cohen A, Gold R, Hasson J, 38. 38. Elvander C, Ahlberg M, Ed- Wengier A, Lessing JB, et al. Risk facqvist M, Stephansson O. Severe perinetors for severe perineal injury during al trauma among women undergoing childbirth: a case–control study of 60 vaginal birth after cesarean delivery: A consecutive cases. Colorectal Disease. population-based cohort study. Birth. 2011;13(8):e216–9. 2019;46(2):379–86.
23. 23.Hudelist G, Gelle’n J, Singer C, Rueck- 39. Smith LA, Price N, Simonite V, Burns linger E, Czerwenka K, Kandolf O, et EE. Incidence of and risk factors for al. Factors predicting severe perineal perineal trauma: a prospective obsertrauma during childbirth: role of forvational study. BMC pregnancy and ceps delivery routinely combined with childbirth. 2013;13(1):1–9. mediolateral episiotomy. American 40. Von Theobald P, Bohrer M, Lorrain journal of obstetrics and gynecology. S, Iacobelli S. Risk factors associat2005;192(3):875–81. ed with severe perineal tears: A five-
24. 24.Jansson MH, Franzén K, Hiyoshi year study. Journal of Gynecology A, Tegerstedt G, Dahlgren H, Nils- Obstetrics and Human Reproduction. son K. Risk factors for perineal and 2020;49(7):101820. vaginal tears in primiparous wom- 41. Durnea CM, Jaffery AE, Gauthaman N, en–the prospective POPRACT-cohort Doumouchtsis SK. Effect of body mass study. BMC pregnancy and childbirth. 2020;20(1):1–14. index on the incidence of perineal trauma. International Journal of Gynecolo-
25. 25.Ampt AJ, Ford JB. Ascertaining severe gy & Obstetrics. 2018;141(2):166–70. perineal trauma and associated risk 42. Gauthaman N, Walters S, Tribe I-A, factors by comparing birth data with Goldsmith L, Doumouchtsis SK. multiple sources. 2015; Shoulder dystocia and associated ma-
26. 26.da Silva FMB, de Oliveira SMJ V, Bick noeuvres as risk factors for perineal D, Osava RH, Tuesta EF, Riesco MLG. trauma. International urogynecology Risk factors for birth-related perinejournal. 2016;27:571–7. al trauma: a cross-sectional study in a Risk Factors For Perineal Injury: A Systematic Review 165