Factors related to obstetric third and fourth degree perineal lacerations in a jamaican cohort

OBJECTIVES: The aim of this study was to identify significant and modifiable risk factors associated with obstetric third and fourth degree perineal lacerations and to produce recommendations that may reduce their morbidity and prevalence. METHODS: This is a retrospective case control study performed between March 2004 and March 2008. All patients diagnosed with third and fourth degree perineal lacerations were identified (cases) along with randomly assigned controls who delivered during the same time period. Nineteen cases and 38 controls were identified giving a total of 57 patients. Each patient's hospital record was collected and the data extracted. RESULTS: When analysed for weight greater than or equal to 3.5 kg versus birthweight of less than 3.5 kg, the difference between cases and controls was found to be statistically significant, with a p value of 0.012. Of the cases, 21% had an operative delivery (forceps or vacuum) whereas only 2.6% of the controls had an operative delivery. This was found to be statistically significant (p = 0.011). CONCLUSIONS: This study has shown that the two main factors related to the obstetric third and fourth degree perineal lacerations were babies weighing more than 3.5 kg and the use of forceps or vacuum to assist with deliveries. These high risk patients should be attended to by the most senior staff that is available. OBJETIVOS: El objetivo de este estudio fue identificar factores de riesgo modificables y significativos asociados con las laceraciones perineales obstetricas de 3er y 4to grado, y producir recomendaciones que puedan reducir su morbilidad y prevalencia. METODOS: Se trata de un estudio de caso control retrospectivo realizado entre marzo de 2004 y marzo de 2008. Todas las pacientes diagnosticadas con laceraciones perineales de 3er y 4to grado fueron identificadas (casos) con controles asignados de manera aleatoria, que tuvieron el parto en el mismo periodo de tiempo. Diecinueve casos y 38 controles fueron identificados, para un total de 57 pacientes. Se recogieron y se extrajeron los datos de las historias clinicas de cada paciente. RESULTADOS: Al analizarseles en terminos de peso superior o igual a 3.5 kg frente a un peso al nacer por debajo de 3.5 kg, la diferencia entre los controles y los casos resulto ser estadisticamente significativa, con un valor p de 0.012. De los casos, el 21% tuvo un parto operativo (forceps o vacio), mientras que solo el 2.6% de los controles tuvo un parto operativo. Esto resulto ser estadisticamente significativo (p = 0.011). CONCLUSIONES: Este estudio ha demostrado que los dos factores principales relacionados con las laceraciones perineales obstetricos de 3er y 4to grado, eran bebes con un peso de mas de 3.5 kg y el uso de forceps o vacio en la asistencia a los partos. Estos pacientes de alto riesgo deben ser atendidos por el personal disponible de mayor experiencia.