Obstetric perineal tears: risk factors, wound infection and dehiscence: a prospective cohort study

Ditte Gommesen*, Ellen Aagaard Nohr, Henrik Christian Drue, Niels Qvist, Vibeke Rasch

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Purpose: To assess risk factors for perineal tears, wound infection and dehiscence among primiparous women. Methods: A prospective cohort study at four Danish hospitals (Odense, Esbjerg, Aarhus and Kolding) among 603 primiparous women sampled in three groups: 203 with none/labia/1st degree, 200 with 2nd degree, and 200 with 3rd/4th degree tears included between July 2015 and January 2018. Baseline data were obtained and a clinical examination of perineal wound healing was performed 11–21 days postpartum. Main outcome measurements were as follows: degree of perineal tear, 1st to 4th, analyzed with a case–control approach, infection (purulent drainage or wound abscess), and wound dehiscence (a gap between wound edges > 0.5 cm). Results: Instrumental delivery and birthweight > 4000 g increased the risk of 3rd/4th degree tears (adjusted Odds Ratio [aOR] 13.7, 95% confidence interval [CI] 5.48–34.1 and aOR 3.27, 95% CI 1.52–7.04, respectively). BMI > 35 kg/m 2 increased the risk of wound infection and dehiscence (aOR 7.66, 95% CI 2.13–27.5 and aOR 3.46, 95% CI 1.10–10.9, respectively). Episiotomy tripled the risk of infection (aOR 2.97, 95% CI 1.05–8.41). Treatment with antibiotics during delivery and postpartum seemed to decrease the risk of dehiscence (aOR 0.32, 95% CI 0.15–0.70). Conclusions: Instrumental delivery and high birth weight increased the risk of perineal tears. Severe obesity and episiotomy increased the risk of perineal wound complications. More focus on these women may be warranted postpartum. The use of prophylactic antibiotics among women in high risk of wound complications should be further investigated in interventional studies.

OriginalsprogEngelsk
TidsskriftArchives of Gynecology and Obstetrics
Vol/bind300
Udgave nummer1
Sider (fra-til)67-77
ISSN0932-0067
DOI
StatusUdgivet - 1. jul. 2019

Fingeraftryk

Obstetrics
Cohort Studies
Prospective Studies
Odds Ratio
Confidence Intervals
Wounds and Injuries
Episiotomy
Morbid Obesity

Citer dette

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title = "Obstetric perineal tears: risk factors, wound infection and dehiscence: a prospective cohort study",
abstract = "Purpose: To assess risk factors for perineal tears, wound infection and dehiscence among primiparous women. Methods: A prospective cohort study at four Danish hospitals (Odense, Esbjerg, Aarhus and Kolding) among 603 primiparous women sampled in three groups: 203 with none/labia/1st degree, 200 with 2nd degree, and 200 with 3rd/4th degree tears included between July 2015 and January 2018. Baseline data were obtained and a clinical examination of perineal wound healing was performed 11–21 days postpartum. Main outcome measurements were as follows: degree of perineal tear, 1st to 4th, analyzed with a case–control approach, infection (purulent drainage or wound abscess), and wound dehiscence (a gap between wound edges > 0.5 cm). Results: Instrumental delivery and birthweight > 4000 g increased the risk of 3rd/4th degree tears (adjusted Odds Ratio [aOR] 13.7, 95{\%} confidence interval [CI] 5.48–34.1 and aOR 3.27, 95{\%} CI 1.52–7.04, respectively). BMI > 35 kg/m 2 increased the risk of wound infection and dehiscence (aOR 7.66, 95{\%} CI 2.13–27.5 and aOR 3.46, 95{\%} CI 1.10–10.9, respectively). Episiotomy tripled the risk of infection (aOR 2.97, 95{\%} CI 1.05–8.41). Treatment with antibiotics during delivery and postpartum seemed to decrease the risk of dehiscence (aOR 0.32, 95{\%} CI 0.15–0.70). Conclusions: Instrumental delivery and high birth weight increased the risk of perineal tears. Severe obesity and episiotomy increased the risk of perineal wound complications. More focus on these women may be warranted postpartum. The use of prophylactic antibiotics among women in high risk of wound complications should be further investigated in interventional studies.",
keywords = "Birth trauma, Perineal care, Perineal trauma, Wound dehiscence, Wound infection",
author = "Ditte Gommesen and Nohr, {Ellen Aagaard} and Drue, {Henrik Christian} and Niels Qvist and Vibeke Rasch",
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Obstetric perineal tears : risk factors, wound infection and dehiscence: a prospective cohort study. / Gommesen, Ditte; Nohr, Ellen Aagaard; Drue, Henrik Christian; Qvist, Niels; Rasch, Vibeke.

I: Archives of Gynecology and Obstetrics, Bind 300, Nr. 1, 01.07.2019, s. 67-77.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Obstetric perineal tears

T2 - risk factors, wound infection and dehiscence: a prospective cohort study

AU - Gommesen, Ditte

AU - Nohr, Ellen Aagaard

AU - Drue, Henrik Christian

AU - Qvist, Niels

AU - Rasch, Vibeke

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Purpose: To assess risk factors for perineal tears, wound infection and dehiscence among primiparous women. Methods: A prospective cohort study at four Danish hospitals (Odense, Esbjerg, Aarhus and Kolding) among 603 primiparous women sampled in three groups: 203 with none/labia/1st degree, 200 with 2nd degree, and 200 with 3rd/4th degree tears included between July 2015 and January 2018. Baseline data were obtained and a clinical examination of perineal wound healing was performed 11–21 days postpartum. Main outcome measurements were as follows: degree of perineal tear, 1st to 4th, analyzed with a case–control approach, infection (purulent drainage or wound abscess), and wound dehiscence (a gap between wound edges > 0.5 cm). Results: Instrumental delivery and birthweight > 4000 g increased the risk of 3rd/4th degree tears (adjusted Odds Ratio [aOR] 13.7, 95% confidence interval [CI] 5.48–34.1 and aOR 3.27, 95% CI 1.52–7.04, respectively). BMI > 35 kg/m 2 increased the risk of wound infection and dehiscence (aOR 7.66, 95% CI 2.13–27.5 and aOR 3.46, 95% CI 1.10–10.9, respectively). Episiotomy tripled the risk of infection (aOR 2.97, 95% CI 1.05–8.41). Treatment with antibiotics during delivery and postpartum seemed to decrease the risk of dehiscence (aOR 0.32, 95% CI 0.15–0.70). Conclusions: Instrumental delivery and high birth weight increased the risk of perineal tears. Severe obesity and episiotomy increased the risk of perineal wound complications. More focus on these women may be warranted postpartum. The use of prophylactic antibiotics among women in high risk of wound complications should be further investigated in interventional studies.

AB - Purpose: To assess risk factors for perineal tears, wound infection and dehiscence among primiparous women. Methods: A prospective cohort study at four Danish hospitals (Odense, Esbjerg, Aarhus and Kolding) among 603 primiparous women sampled in three groups: 203 with none/labia/1st degree, 200 with 2nd degree, and 200 with 3rd/4th degree tears included between July 2015 and January 2018. Baseline data were obtained and a clinical examination of perineal wound healing was performed 11–21 days postpartum. Main outcome measurements were as follows: degree of perineal tear, 1st to 4th, analyzed with a case–control approach, infection (purulent drainage or wound abscess), and wound dehiscence (a gap between wound edges > 0.5 cm). Results: Instrumental delivery and birthweight > 4000 g increased the risk of 3rd/4th degree tears (adjusted Odds Ratio [aOR] 13.7, 95% confidence interval [CI] 5.48–34.1 and aOR 3.27, 95% CI 1.52–7.04, respectively). BMI > 35 kg/m 2 increased the risk of wound infection and dehiscence (aOR 7.66, 95% CI 2.13–27.5 and aOR 3.46, 95% CI 1.10–10.9, respectively). Episiotomy tripled the risk of infection (aOR 2.97, 95% CI 1.05–8.41). Treatment with antibiotics during delivery and postpartum seemed to decrease the risk of dehiscence (aOR 0.32, 95% CI 0.15–0.70). Conclusions: Instrumental delivery and high birth weight increased the risk of perineal tears. Severe obesity and episiotomy increased the risk of perineal wound complications. More focus on these women may be warranted postpartum. The use of prophylactic antibiotics among women in high risk of wound complications should be further investigated in interventional studies.

KW - Birth trauma

KW - Perineal care

KW - Perineal trauma

KW - Wound dehiscence

KW - Wound infection

U2 - 10.1007/s00404-019-05165-1

DO - 10.1007/s00404-019-05165-1

M3 - Journal article

C2 - 31004221

AN - SCOPUS:85064687802

VL - 300

SP - 67

EP - 77

JO - Archives of Gynecology and Obstetrics

JF - Archives of Gynecology and Obstetrics

SN - 0932-0067

IS - 1

ER -