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 accumulate current evidence and provide estimated effect sizes
for the various risk factors described. We reviewed Medline, Scopus, Clinicaltrials.gov,
EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar
for published studies in the field for observational studies as well as randomized
controlled trials. Two researchers independently assessed the included studies and
documented outcomes. Data extraction was performed using a modified data form that
was based in Cochrane`s data collection form for intervention reviews for RCTs and
non-RCTs. Forty-three articles were selected for inclusion in the present systematic
review. The analyzed population reached 716,031 parturient of whom 22,280 (3,1%) sustained
third- and fourth-degree perineal lacerations. Several risk factors were identified.
Instrumental delivery [RR 3.38 (2.21, 5.18)], midline episiotomy [RR 2.88 (1.79, 4.65)]
and a persistent occiput posterior position [RR 2.73 (2.08, 3.58)] were associated
with the higher risk of developing severe perineal lacerations. Mediolateral episiotomy
did not increase, but was also not protective against perineal lacerations [RR 1.55
(0.95, 2.53)]. Several factors contribute to the development of severe perineal lacerations.
The present meta-analysis presents accumulated data that may help physicians estimate
risks and provide appropriate patient counseling.
Keywords
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Article info
Publication history
Published online: February 14, 2020
Accepted:
February 13,
2020
Received in revised form:
February 11,
2020
Received:
January 6,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
