Document Detail

Anal sphincter lacerations and upright delivery postures--a risk analysis from a randomized controlled trial.
MedLine Citation:
PMID:  16636770     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate obstetric sphincter lacerations after a kneeling or sitting position at second stage of labor in a multivariate risk analysis model.
MATERIALS AND METHODS: Two hundred and seventy-one primiparous women with normal pregnancies and spontaneous labor were randomized, 138 to a kneeling position and 133 to a sitting position. Medical data were retrieved from delivery charts and partograms. Risk factors were tested in a multivariate logistic regression model in a stepwise manner.
RESULTS: The trial was completed by 106 subjects in the kneeling group and 112 subjects in the sitting group. There were no significant differences with regard to duration of second stage of labor or pre-trial maternal characteristics between the two groups. Obstetrical sphincter tears did not differ significantly between the two groups but an intact perineum was more common in the kneeling group (p<0.03) and episiotomy (mediolateral) was more common in the sitting group (p<0.05). Three grade IV sphincter lacerations occurred in the sitting group compared to none in the kneeling group (NS). Multivariate risk analysis indicated that prolonged duration of second stage of labor and episiotomy were associated with an increased risk of third- or fourth-degree sphincter tears (p<0.01 and p<0.05, respectively). Delivery posture, maternal age, fetal weight, use of oxytocin, and use of epidural analgesia did not increase the risk of obstetrical anal sphincter lacerations in the two upright postures.
CONCLUSION: Obstetrical anal sphincter lacerations did not differ significantly between a kneeling or sitting upright delivery posture. Episiotomy was more common after a sitting delivery posture, which may be associated with an increased risk of anal sphincter lacerations. Upright delivery postures may be encouraged in healthy women with normal, full-term pregnancy.
Daniel Altman; Inga Ragnar; Asa Ekström; Tanja Tydén; Sven-Eric Olsson
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2006-04-25
Journal Detail:
Title:  International urogynecology journal and pelvic floor dysfunction     Volume:  18     ISSN:  -     ISO Abbreviation:  Int Urogynecol J Pelvic Floor Dysfunct     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2006-12-29     Completed Date:  2007-04-04     Revised Date:  2011-08-18    
Medline Journal Info:
Nlm Unique ID:  9514583     Medline TA:  Int Urogynecol J Pelvic Floor Dysfunct     Country:  England    
Other Details:
Languages:  eng     Pagination:  141-6     Citation Subset:  IM    
Pelvic Floor Center, Department of Obstetrics and Gynecology, Karolinska Institute Danderyd Hospital, Stockholm, Sweden.
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MeSH Terms
Anal Canal / injuries*
Delivery, Obstetric / adverse effects,  methods*
Episiotomy / statistics & numerical data
Lacerations / epidemiology,  etiology*
Multivariate Analysis
Outcome Assessment (Health Care)
Perineum / injuries

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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