Baylor University Medical Center Proceedings April 2017 - 153


Table 3. Relation of patient characteristics to two laceration subgroups
Laceration subgroups
Third or
None, first, or
second degree fourth degree
P
(n = 5)
(n = 122)
value*

Variable
Perineal body length (cm)

3.7 (0.5)

3.4 (0.4)

0.1

Age (years)

23.5 (4.7)

27.0 (3.0)

0.1

The long-term morbidity associated with severe
perineal lacerations remains signiﬁcant. We need
to continue to better characterize the risk factors
that can lead to these unwanted outcomes. Further
research in the area of perineal anatomy may help
patients avoid severe lacerations.
1.

Borello-France D, Burgio KL, Richter HE, Zyczynski H,
Fitzgerald MP, Whitehead W, Fine P, Nygaard I, Handa
VL, Visco AG, Weber AM, Brown MB; Pelvic Floor DisGestational age (weeks)
39.6 (1.1)
39.5 (1.3)
0.9
orders Network. Fecal and urinary incontinence in pri2
Body mass index (kg/m )
31.2 (5.9)
32.6 (5.4)
0.6
miparous women. Obstet Gynecol 2006;108(4):863-872.
2. Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO.
Baby weight (g)
3363 (407)
3441 (285)
0.7
Fecal and urinary incontinence after vaginal delivery with
Length of second stage (min)
56 (43)
99 (32)
0.03
anal sphincter disruption in an obstetrics unit in the United
Race (% white)
65
80
0.5
States. Am J Obstet Gynecol 2003;189(6):1543-1549.
3. Haadem K, Dahlström JA, Lingman G. Anal sphincter
Presentation (% occiput anterior)
98
100
0.8
function after delivery: a prospective study in women with
Episiotomy (% without)
98
100
0.8
sphincter rupture and controls. Eur J Obstet Gynecol Reprod
Delivery type (% without operative vaginal delivery)
86
40
0.006
Biol 1990;35(1):7-13.
4. Klein MC, Gauthier RJ, Robbins JM, Kaczorowski J,
Oxytocin used (%)
83
100
0.3
Jorgensen SH, Franco ED, Johnson B, Waghorn K,
*The first six variables were examined using Student's t test, and the last five variables by chi-square test.
Gelfand MM, Guralnick MS, et al. Relationship of
episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic ﬂoor relaxation. Am J Obstet Gynecol
1994;171(3):591-598.
Table 4. Logistic regression model for relation of factors to development of
5. Safarinejad MR, Kolahi AA, Hosseini L. The eﬀect of the
mode of delivery on the quality of life, sexual function,
third- or fourth-degree laceration in nulliparous patients*
and sexual satisfaction in primiparous women and their
P
Odds 95% CI for
husbands. J Sex Med 2009;6(6):1645-1667.
Factor
Criterion† Coefficient value ratio odds ratio
6. Christianson LM, Bovbjerg VE, McDavitt EC, Hullﬁsh
KL. Risk factors for perineal injury during delivery. Am J
Duration of second stage (min)
>99
3.47
0.035 32 1.3 to 807
Obstet Gynecol 2003;189(1):255-260.
Perineal body length (cm)
3.19
0.033 24 1.3 to 456
≤3.5
7. Sultan AH, Kamm MA, Hudson CN, Bartram CI. Third
degree obstetric anal sphincter tears: risk factors and outPatient age (years)
>26
2.41
0.15
11 0.43 to 293
come of primary repair. BMJ 1994;308(6933):887-891.
Spontaneous vaginal delivery (SVD) SVD = 1,
-0.29
0.86 0.75 0.03 to 17.9
8. Zetterström J, López A, Anzén B, Norman M, Holmström
without use of forceps or vacuum
others = 0
B, Mellgren A. Anal sphincter tears at vaginal delivery:
risk factors and clinical outcome of primary repair. Obstet
*Overall model P = 0.0004 with 98% of 127 cases correctly classified.
†Criteria were developed for quantitative variables using receiver-operator curve analyses. Perineal body
Gynecol 1999;94(1):21-28.
length: area under the curve (AUC) of 0.71; P = 0.047; sensitivity 80%; specificity 66%. Age: AUC of
9. Groves JW Jr, Foster RT, Kuehl TJ, Yandell PM. Risk and
0.75; P = 0.005; sensitivity 80%; specificity 75%. Second stage duration: AUC of 0.82; P < 0.0001;
outcome of obstetrical anal sphincter injury. J Pelvic Med
sensitivity 80%; specificity 88%.
Surg 2007;13(4):171-176.
10. Rizk DE, Thomas L. Relationship between the length of
the perineum and position of the anus and vaginal delivery
in primigravidae. Int Urogynecol J Pelvic Floor Dysfunct 2000;11(2):79-83.
One strength of our study was its inclusion of only pri11. Aytan H, Tapisiz OL, Tuncay G, Avsar FA. Severe perineal lacerations in
migravid women. As in the study by Tsai et al, excluding
nulliparous women and episiotomy type. Eur J Obstet Gynecol Reprod Biol
multiparous patients excludes the potential bias of parity on
2005;121(1):46-50.
perineal body length (14). Also, primigravid patients have a
12. Dua A, Whitworth M, Dugdale A, Hill S. Perineal length: norms in gravid
women in the ﬁrst stage of labour. Int Urogynecol J Pelvic Floor Dysfunct
greater risk of severe lacerations. We also had two physicians
2009;20(11):1361-1364.
performing most measurements, which decreased interobserver
13. Deering SH, Carlson N, Stitely M, Allaire AD, Satin AJ. Perineal body
bias on perineal body lengths. This was also a weakness in that
length and lacerations at delivery. J Reprod Med 2004;49(4):306-310.
patient collection was limited to the times when those physi14. Tsai PJ, Oyama IA, Hiraoka M, Minaglia S, Thomas J, Kaneshiro B.
cians were working in the labor and delivery unit. Although
Perineal body length among diﬀerent racial groups in the ﬁrst stage of
labor. Female Pelvic Med Reconstr Surg 2012;18(3):165-167.
our study showed signiﬁcance, having a higher patient volume
15. O'Boyle AL, O'Boyle JD, Ricks RE, Patience TH, Calhoun B, Davis G.
would likely have increased the number of severe lacerations,
The natural history of pelvic organ support in pregnancy. Int Urogynecol
strengthening our data. We also had a very low rate of third- and
J Pelvic Floor Dysfunct 2003;14(1):46-49.

fourth-degree lacerations, at 3.9%.

April 2017

Perineal body length and perineal lacerations during delivery in primigravid patients

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