Risk Factors for Perineal Tears in Normal Vaginal Births

Abstract

Aim: This research was planned as a prospective, descriptive study for the purpose of determining risk factors for the development of perineal tears in women having vaginal birth. Methods: A total of 537 women were monitored during childbirth in the study. The obstetric conditions that were observed during the second and third stage of labor and episiotomy repair were recorded on the diagnosis form. After delivery perineal tears were classified as first, second, third or fourth degree. These tears were also evaluated according to whether they were present together with episiotomy. Results: Correlations to an advanced degree were found in this study between perineal tears and parity, use of fundal pressure, length of labor, episiotomy time, and use of oxytocin and dolantin (pethidin) as well as between cervical tears and use of fundal pressure. In the logistic regression analysis it was determined that fundal pressure and length of second stage of labor were risk factors for the development of perineal tears. Conclusion: Interventions for shortening the second stage of labor, particularly the use of fundal pressure cause perineal and cervical tears. Therefore, interventions in the management of second stage should be decided and used very carefully.

Zusammenfassung

Einleitung: Prospektive Studie zur Ermittlung von Faktoren welche das Risiko eines Dammrisses bei Spontangeburt erhöhen. Patientinnen und Methode: In der Studie wurden 537 Frauen während und nach einer Spontangeburt beobachtet. Die geburtshilflichen Parameter während der Eröffnungs-, Austreibungs- und postpartalen Periode wurden aufgezeichnet und analysiert. Die Dammrisse wurden in 4 Grade eingeteilt. Ergebnisse: In der Studie konnte ein Zusammenhang zwischen dem Grad der Dammrisse mit der Parität der Patientin, einem möglichen Kristeller-Manöver, der Wehendauer, dem Zeitpunkt einer Episiotomie und dem Einsatz von Oxytocin bzw. Pethidin gezeigt werden. Des Weiteren zeigte sich ein Zusammenhang von Zervixrissen mit einem durchgeführten Kristeller-Manöver. In der logistischen Regressionsanalyse konnte die positive Korrelation zwischen der Länge der Austreibungsperiode und einem Kristeller-Manöver mit der Entwicklung von Dammrissen bestätigt werden. Schlussfolgerung: Insbesondere Maßnahmen zur Verkürzung der Austreibungsperiode wie beispielsweise das Kristeller-Manöver haben einen Einfluss auf die Entstehung von Dammrissen und sollten deshalb vorsichtig eingesetzt werden.

Key words

perineal tear - second stage of labor - vaginal delivery - episiotomy - fundal pressure

Schlüsselwörter

Dammriss - 2. Abschnitt der Gebärphase - vaginale Entbindung - Episiotomie - Fundaldruck

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