THIRD- AND FOURTH-DEGREE PERINEAL TEARS AND RESTRICTIVE USE OF EPISIOTOMY

Abstract

Cilj: Utvrditi ukupan broj i učestalost razdora međice III. i IV. stupnja u uporabi restriktivne epiziotomije te učestalost opstetričkih ozljeda analnog sfi nktera (OASIS) u odnosu na paritet, način dovršenja porođaja, trajanje porođaja, epiduralnu analgeziju, iskustvo porodničkog tima, porođajnu težinu i opseg glave novorođenčeta. Ispitanice i metode: U retrospektivno kliničko istraživanje uključena je 51 rodilja koje su rodile na Klinici za ginekologiju i porodništvo KB-a Sveti Duh u razdoblju od 1. siječnja 2010 do 31. prosinca 2014. s dijagnozom OASIS. Rezultati: Od ukupno 12858 vaginalnih porođaja, 77 % (n=9887) žena nije imalo epiziotomiju, dok je 23% (n=2971) imalo epiziotomiju. Ukupna učestalost OASIS-a u promatranom razdoblju iznosila je 0,4%, s mediolateralnom epiziotomijom (0,7%) u odnosu na žene bez epiziotomije (0,3 %; p0,05). Zaključak: Kao rizični čimbenici za nastanak OASIS-a pokazali su se prvorodnost, duljina trajanja porođaja više od deset sati te primjena epiziotomije. U trećini slučajeva s OASIS-om bili su prisutni ostali opstetrički rizični čimbenici za nastanak OASIS-a. Restriktivna uporaba epiziotomije i manualna perinealna protekcija smanjuju incidenciju razdora III. i IV. stupnja.Aim: To determine the number and prevalence of third- and fourth-grade perineal tears with restrictive use of episiotomy, and the prevalence of obstetric anal sphincter injuries (OASIS) according to parity, mode of labor termination, delivery duration, epidural analgesia, obstetric team experience, and neonatal birth weight and head circumference. Subjects and Methods: This retrospective clinical study included 51 women diagnosed with OASIS, having delivered their newborns at Department of Gynecology and Obstetrics, Sveti Duh University Hospital from January 1, 2010 until December 31, 2014. Results: Out of 12858 vaginal deliveries, episiotomy was not used in 77% (n=9887), whereas it was used in 23% (n=2971) of women. The overall prevalence of OASIS during the study period was 0.4%, with 0.7% for mediolateral episiotomy versus 0.3% in women without episiotomy (p10 hours (p4000 g (21.6%), maternal body mass index, and second stage of labor >1 hour (43.6%) versus 0.05 both). Conclusion: Primiparity, delivery duration >10 hours, and use of episiotomy were identifi ed as risk factors for OASIS. Other obstetric risk factors for OASIS were present in one-third of OASIS cases. The prevalence of third- and fourth-degree perineal tears can be reduced with restrictive use of episiotomy and manual perineal protection