Racial differences in severe perineal lacerations after vaginal delivery

Jay Goldberg, Terry Hyslop, Jorge Tolosa, Carmen Sultana

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

OBJECTIVE: The purpose of this study was to determine the relationship between maternal race and rates of third- and fourth-degree laceration after vaginal delivery. STUDY DESIGN: An electronic audit of the medical procedures database at Thomas Jefferson University Hospital from 1983 through 2000 was completed. Univariate and multivariable models were computed with the use of logistic regression models. RESULTS: From the database, 34,048 vaginal deliveries were identified, with 3487 deliveries resulting in third- or fourth-degree laceration (10.2%). Overall severe laceration rates by race with all vaginal deliveries for patients without and with episiotomy were as follows: white, 4.3% and 15.1%; black, 2.0% and 19.3%; Asian 9.1% and 32.3%; Hispanic, 3.4% and 17.0%, respectively. After being controled for other variables with multivariable logistic regression in all vaginal deliveries, Asian race (odds ratio, 2.04; 95% CI, 1.43-2.92), forceps (odds ratio, 3.71; 95% CI, 3.39-4.05), vacuum-assisted delivery (odds ratio, 1.86; 95% CI, 1.64-2.10), large size for gestational age (odds ratio, 1.94; 95% CI, 1.21-3.09), and episiotomy (odds ratio, 3.09; 95% CI, 2.66-3.59) were associated significantly with severe lacerations. CONCLUSION: Race is an independent risk factor for severe perineal lacerations after vaginal delivery, with Asian women at highest risk. Asian women who undergo episiotomy and operative vaginal delivery are especially at high risk for rectal sphincter injury.

Original languageEnglish (US)
Pages (from-to)1063-1067
Number of pages5
JournalAmerican Journal of Obstetrics and Gynecology
Volume188
Issue number4
DOIs
StatePublished - Apr 1 2003
Externally publishedYes

Fingerprint

Lacerations
Episiotomy
Odds Ratio
Logistic Models
Medical Electronics
Medical Audit
Databases
Vacuum
Hispanic Americans
Surgical Instruments
Gestational Age
Mothers
Wounds and Injuries

Keywords

  • Asian
  • Episiotomy
  • Perineal laceration
  • Race

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Racial differences in severe perineal lacerations after vaginal delivery. / Goldberg, Jay; Hyslop, Terry; Tolosa, Jorge; Sultana, Carmen.

In: American Journal of Obstetrics and Gynecology, Vol. 188, No. 4, 01.04.2003, p. 1063-1067.

Research output: Contribution to journalArticle

Goldberg, Jay ; Hyslop, Terry ; Tolosa, Jorge ; Sultana, Carmen. / Racial differences in severe perineal lacerations after vaginal delivery. In: American Journal of Obstetrics and Gynecology. 2003 ; Vol. 188, No. 4. pp. 1063-1067.
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abstract = "OBJECTIVE: The purpose of this study was to determine the relationship between maternal race and rates of third- and fourth-degree laceration after vaginal delivery. STUDY DESIGN: An electronic audit of the medical procedures database at Thomas Jefferson University Hospital from 1983 through 2000 was completed. Univariate and multivariable models were computed with the use of logistic regression models. RESULTS: From the database, 34,048 vaginal deliveries were identified, with 3487 deliveries resulting in third- or fourth-degree laceration (10.2{\%}). Overall severe laceration rates by race with all vaginal deliveries for patients without and with episiotomy were as follows: white, 4.3{\%} and 15.1{\%}; black, 2.0{\%} and 19.3{\%}; Asian 9.1{\%} and 32.3{\%}; Hispanic, 3.4{\%} and 17.0{\%}, respectively. After being controled for other variables with multivariable logistic regression in all vaginal deliveries, Asian race (odds ratio, 2.04; 95{\%} CI, 1.43-2.92), forceps (odds ratio, 3.71; 95{\%} CI, 3.39-4.05), vacuum-assisted delivery (odds ratio, 1.86; 95{\%} CI, 1.64-2.10), large size for gestational age (odds ratio, 1.94; 95{\%} CI, 1.21-3.09), and episiotomy (odds ratio, 3.09; 95{\%} CI, 2.66-3.59) were associated significantly with severe lacerations. CONCLUSION: Race is an independent risk factor for severe perineal lacerations after vaginal delivery, with Asian women at highest risk. Asian women who undergo episiotomy and operative vaginal delivery are especially at high risk for rectal sphincter injury.",
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