Factors Associated With Perineal Lacerations Requiring Suture in Vaginal Births Without Episiotomy

Abstract

INTRODUCTION: With the adoption of a policy of restrictive episiotomy, the interest in studying and preventing spontaneous lacerations in childbirth has increased. The present study was conducted to determine the main risk factors for perineal lacerations requiring suture in vaginal deliveries without episiotomy. METHODS: We conducted a prospective cohort study including 400 vaginal deliveries assisted in a public hospital in Brazil. During the second stage of labor, maneuvers as such directed pushing, fundal pressure, and Valsalva maneuver were avoided. A policy of no episiotomy was followed with strategies for perineal protection that included warm compresses and intrapartum perineal massage. We calculated the relative risk and its 95% confidence interval (95% CI). Multivariate analysis was performed to determine the adjusted risk of need for suture. RESULTS: We analyzed 400 women who had vaginal deliveries with no episiotomy and 6% of instrumental deliveries. The rate of perineal lacerations in primiparous (210) was 56.7% and in multiparous (190) 30%. Suture was necessary in 23% of women (30% of primiparous and 15.3% of multiparous). In multivariate analysis, the factors that remained associated with increased risk of need for suture were primiparity (adjusted risk 1.81, 95% CI 1.25–2.89) and instrumental delivery (adjusted risk 3.78, 95% CI 1.21–18.66). CONCLUSION: There was a reduced need for suture in vaginal deliveries with the application of a protocol of perineal protection and no episiotomy. Primiparity and instrumental delivery were associated with increased risk of need for suture.