How many women have perineal trauma at delivery?

  • Caudwell-Hall J & al.
  • Am J Obstet Gynecol
  • 28 Jul 2018

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • 33%-40% of women who deliver vaginally can expect a normal delivery without pelvic floor trauma.

Why this matters

  • Undiagnosed pelvic floor trauma may be higher than previously thought.
  • This information may be used as an indication for elective primary cesarean delivery (CD).

Key results

  • 23% of cohort had CD.
  • Of the vaginal deliveries (n=374), 21% had operative delivery and 4% had a third- or fourth-degree laceration.
  • 51.9% had a "normal" vaginal delivery.
  • Women with CD had no evidence of perineal trauma.
  • Model 1:
    • 27 women suffered an avulsion; 
    • 31 women had a residual sphincter defect on ultrasound; and 
    • 40% had a normal outcome.
  • Model 2:
    • 58 women had levator avulsion or sphincter defect;
    • 33 had irreversible overdistension; and
    • 33% had a normal outcome.
  • Younger age and earlier gestation were associated with atraumatic normal delivery.

Study design

  • Retrospective secondary analysis, data from a prior data set gathered in the context of an interventional perinatal imaging study.
  • Primiparous women underwent interviews in the antepartum and postpartum periods, vaginal exams, and 4D translabial ultrasound to examine levator trauma and/or overdistension and residual sphincter defects (n=483).
  • 2 models were used to diagnose trauma.
  • Funding: None disclosed.

Limitations

  • Follow-up rate was only 76%.

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