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.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Archives of Gynecology and Obstetrics |
| Vol/bind | 300 |
| Udgave nummer | 1 |
| Sider (fra-til) | 67-77 |
| ISSN | 0932-0067 |
| DOI | |
| Status | Udgivet - 1. jul. 2019 |
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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 tidsskrift › Tidsskriftartikel › Forskning › peer 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 -