Background: Most vaginal deliveries result in more or less severe vaginoperineal lacerations, spontaneous (I, II, III, IV degree) or iatrogenic (episiotomy). Although nulliparity is recognized in the literature as a risk factor for perineal damage, multiparous women also suffer from lacerations and sometimes these worsen in later births. There are many variables considered: maternal (age, BMI, ethnicity, recourse to epidural analgesia), obstetricians (duration of the first and second stages of labor, induction of labor, position at delivery, use of hot cloths in expulsive, presence of obstetric students at birth, type of delivery, previous laceration or episiotomy) and neonatal (gestational period, neonatal weight). Objective: The aim of the study is to define the risk factors for the worsening of obstetric perineal damage in pluriparous women. I, II, III and IV degree lacerations and the use of episiotomy are considered. Design: This is a retrospective observational study that includes women who have had a vaginal birth at the Ca 'Foncello Hospital in Treviso between 1 October 2017 and 30 September 2022. The inclusion criteria include single pregnancies, with presentation of summit and the multiparity of the pregnant woman. Results: The analyzed sample includes a total of 146 women. The statistical analysis found association between the variables parity (p = 0.0118), severity of the previous laceration (p = 0.00176 e <0.001) semi-sitting positions (p <0.001.) and the worsening of perineal damage. Furthermore, association was also found between use of episiotomy at the second delivery and increased BMI (p = 0.008) and previous 2nd degree laceration (p <0.001). The worsening of the damage is not associated with prolonged gestational age, induction, increased neonatal weight, presence of students at delivery and epidural analgesia. Conclusion: High parity and intact perineum at the previous delivery affect tear severity at the subsequent delivery. The semi-sitting positions, increased BMI and previous 2nd degree lacerations involve a higher risk of incurring a worse spontaneous or provoked perineal damage
Background: La maggior parte dei parti vaginali sfocia in lacerazioni vaginoperineali più o meno severe, spontanee (I, II, III, IV grado) o iatrogene (episiotomia). Sebbene la nulliparità sia riconosciuta dalla letteratura come fattore di rischio per il danno perineale, anche le donne multipare incorrono in lacerazioni e talvolta queste peggiorano nei parti successivi. Molteplici sono le variabili considerate: materne (età, BMI, etnia, ricorso all’analgesia peridurale), ostetriche (durata del primo e secondo stadio del travaglio, induzione del travaglio, posizione al parto, utilizzo di pezze calde in espulsivo, presenza di studenti ostetriche al parto, tipologia di parto, lacerazione o episiotomia pregressa) e neonatali (epoca gestazionale, peso neonatale). Obiettivi: Lo scopo dello studio è quello di definire i fattori di rischio per il peggioramento del danno perineale ostetrico nelle donne pluripare. Vengono considerate le lacerazioni di I, II, III e IV grado e il ricorso all’episiotomia. Disegno di studio: Si tratta di uno studio osservazionale retrospettivo che include le donne che hanno espletato un parto vaginale presso l’Ospedale Ca’ Foncello di Treviso tra il 1° Ottobre 2017 e il 30 Settembre 2022. I criteri di inclusione prevedono gravidanze singole, con presentazione di vertice e la pluriparità della gestante. Risultati: Il campione analizzato comprende un totale di 146 donne. L’analisi statistica ha rilevato associazione tra le variabili parità (p = 0.0118), gravità della lacerazione pregressa (p.= 0.00176 e <0.001), posizioni semisedute (p <0.001) ed il peggioramento del danno perineale. Inoltre, è stata rilevata associazione anche tra ricorso ad episiotomia al secondo parto ed aumento del BMI (p =0.008) e pregressa lacerazione di II grado (p <0.001). Il peggioramento del danno non è associabile a epoca gestazionale protratta, induzione, peso neonatale aumentato, presenza di studenti al parto e analgesia peridurale. Conclusioni: Elevata parità e perineo integro al parto precedente incidono sulla gravità della lacerazione al parto successivo. Le posizioni semisedute, l’aumento del BMI e pregresse lacerazioni di II grado comportano rischio più elevato di incorrere in un danno perineale peggiore spontaneo o provocato.
Peggioramento del danno perineale nelle pluripare: fattori di rischio
ZANCHIN, SANDY
2021/2022
Abstract
Background: Most vaginal deliveries result in more or less severe vaginoperineal lacerations, spontaneous (I, II, III, IV degree) or iatrogenic (episiotomy). Although nulliparity is recognized in the literature as a risk factor for perineal damage, multiparous women also suffer from lacerations and sometimes these worsen in later births. There are many variables considered: maternal (age, BMI, ethnicity, recourse to epidural analgesia), obstetricians (duration of the first and second stages of labor, induction of labor, position at delivery, use of hot cloths in expulsive, presence of obstetric students at birth, type of delivery, previous laceration or episiotomy) and neonatal (gestational period, neonatal weight). Objective: The aim of the study is to define the risk factors for the worsening of obstetric perineal damage in pluriparous women. I, II, III and IV degree lacerations and the use of episiotomy are considered. Design: This is a retrospective observational study that includes women who have had a vaginal birth at the Ca 'Foncello Hospital in Treviso between 1 October 2017 and 30 September 2022. The inclusion criteria include single pregnancies, with presentation of summit and the multiparity of the pregnant woman. Results: The analyzed sample includes a total of 146 women. The statistical analysis found association between the variables parity (p = 0.0118), severity of the previous laceration (p = 0.00176 e <0.001) semi-sitting positions (p <0.001.) and the worsening of perineal damage. Furthermore, association was also found between use of episiotomy at the second delivery and increased BMI (p = 0.008) and previous 2nd degree laceration (p <0.001). The worsening of the damage is not associated with prolonged gestational age, induction, increased neonatal weight, presence of students at delivery and epidural analgesia. Conclusion: High parity and intact perineum at the previous delivery affect tear severity at the subsequent delivery. The semi-sitting positions, increased BMI and previous 2nd degree lacerations involve a higher risk of incurring a worse spontaneous or provoked perineal damageFile | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/38359