ArticleAJOG global reports2023
Risk factors associated with severe perineal lacerations during vaginal delivery: a 10-year propensity score-matched observational study.
Article in AJOG global reports, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Hyaluronidase for reducing perineal trauma.The Cochrane database of systematic reviews · 2024Pooled it
- Incidence and Independent Risk Factors for Obstetric Anal Sphincter Injuries: A Four-Year Retrospective Cohort Study from a UK Tertiary Maternity Unit.Journal of clinical medicine · 2026Article
- Episiotomy and Obstetric Anal Sphincter Injury Among Unassisted Vaginal Births: A Retrospective Cohort Study.The Australian & New Zealand journal of obstetrics & gynaecology · 2026Article
- The association between epidural analgesia and perineal injury in primiparous women: A propensity score-matched cohort study.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Article
- Episiotomy and severe perineal laceration among Asian American, Native Hawaiian, and Pacific Islander nulliparous individuals in California.AJOG global reports · 2025Article
- The Impact of Pelvic Floor Muscle Strengthening on the Functional State of Women Who Have Experienced OASIS After Childbirth.Medicina (Kaunas, Lithuania) · 2024Article
- The "Ideal Birth": The Occurrence of Severe Perineal Lacerations, Related Factors and the Possibility of Identifying Patients at Higher Risk.Healthcare (Basel, Switzerland) · 2024Article
- Effects of Perineal Warm Compresses during the Second Stage of Labor on Reducing Perineal Trauma and Relieving Postpartum Perineal Pain in Primiparous Women: A Systematic Review and Meta-Analyses.Healthcare (Basel, Switzerland) · 2024Review
Corrections and comments
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Authors and funding
8 authors at 1 institution in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSevere perineal lacerations are rare obstetrical complications in high-income countries. However, the prevention of obstetric anal sphincter injuries is crucial because of their long-term consequences on a woman's digestive function, sexual-mental health, and well-being. The probability of obstetric anal sphincter injuries can be predicted by assessing antenatal and intrapartum risk factors.
objectiveThis study aimed to assess the incidence of obstetric anal sphincter injuries at a single institution for 10 years and to identify women more at risk by evaluating the relationship between antenatal and intrapartum risk factors and severe perineal tears. The main outcome measured in this study was the occurrence of obstetric anal sphincter injuries during vaginal delivery. STUDY
designThis was an observational retrospective cohort study conducted at a University Teaching Hospital in Italy. The study was conducted from 2009 to 2019 using a prospectively maintained database. The study cohort included all women with singleton pregnancy at term who delivered via vaginal delivery in cephalic presentation. Of note, data analysis was performed in 2 stages: a propensity score matching to balance possible differences between patients with obstetric anal sphincter injuries and those without and a stepwise univariate and multivariate logistic regression. A secondary analysis was performed to further evaluate the effect of parity, epidural anesthesia, and duration of the second stage of labor by adjusting for potential confounders.
resultsOf 41,440 patients screened for eligibility, 22,156 met the inclusion criteria, and 15,992 were balanced after propensity score matching. Obstetric anal sphincter injuries occurred in 81 cases (0.4%), 67 (0.3%) after spontaneous delivery and 14 (0.8%) after vacuum delivery(
conclusionSevere perineal lacerations were found to be a rare complication of vaginal delivery. By using a robust statistical model, such as propensity score matching, we were able to investigate a broad range of antenatal and intrapartum risk factors, including use of epidural anesthesia, number of obstetrics examinations, and patient position at birth, which are usually underreported. Moreover, we found that women who delivered for the first time without epidural anesthesia had the highest risk of obstetric anal sphincter injuries.
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