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Risk factors for severe perineal trauma during childbirth: An updated meta-analysis

  • Vasilios Pergialiotis
    Correspondence
    Corresponding author at: 6, Danaidon str., Halandri, 15232, Greece.
    Affiliations
    Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece

    Second Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
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  • Ioannis Bellos
    Affiliations
    Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece
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  • Maria Fanaki
    Affiliations
    Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece
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  • Nikolaos Vrachnis
    Affiliations
    Second Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
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  • Stergios K. Doumouchtsis
    Affiliations
    Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece

    Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom

    St George's University of London, London, United Kingdom
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Published:February 14, 2020DOI:https://doi.org/10.1016/j.ejogrb.2020.02.025

      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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