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

Authors
  • Pergialiotis, Vasilios1
  • Bellos, Ioannis2
  • Fanaki, Maria2
  • Vrachnis, Nikolaos3
  • Doumouchtsis, Stergios K4
  • 1 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. Electronic address: [email protected] , (Greece)
  • 2 Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece. , (Greece)
  • 3 Second Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece. , (Greece)
  • 4 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. , (United Kingdom)
Type
Published Article
Journal
European journal of obstetrics, gynecology, and reproductive biology
Publication Date
Feb 14, 2020
Volume
247
Pages
94–100
Identifiers
DOI: 10.1016/j.ejogrb.2020.02.025
PMID: 32087423
Source
Medline
Keywords
Language
English
License
Unknown

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. Copyright © 2020 Elsevier B.V. All rights reserved.

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