Acta obstetricia et gynecologica Scandinavica · 2026
Risk factors associated with deep perineal wound dehiscence after second-degree perineal tears or episiotomy.
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Golmann Denise, Hedström Josefin, Epstein Elisabeth, Bergman Ida
Аннотация
INTRODUCTION: Second-degree perineal tears and episiotomies, involving the bulbocavernosus and/or superficial transverse perineal muscles, are common after vaginal birth and may lead to wound dehiscence, infection, and long-term pelvic floor dysfunction. Despite this, risk factors for deep wound dehiscence involving perineal musculature remain insufficiently studied. This study aimed to identify risk factors for wound dehiscence in second-degree tears and episiotomies to inform potential use of antibiotic prophylaxis.
MATERIAL AND METHODS: A single-center case-control study (1:2 ratio) was conducted including 105 cases with 2nd degree perineal tears or episiotomies complicated by deep wound dehiscence, diagnosed within two weeks postpartum and 210 controls with second-degree tears or episiotomies without dehiscence. Exposure data were retrieved from medical records. Univariate analyses were performed on a priori selected exposure variables, using Mann-Whitney U and Fisher's exact tests. Variable selection used Lasso regression with leave-one-out cross-validation. Multivariate logistic regression generated adjusted odds ratios (aOR). Statistical significance was set at p < 0.05.
RESULTS: Women with wound dehiscence were more often vaginal primiparas (87% vs 69%, p < 0.001) and had higher rates of episiotomy (33% vs 7%, p < 0.001). Intrapartum antibiotics were administered less frequently among cases (7% vs 20%, p = 0.002). Cases had longer second stage of labor, more active pushing, and greater postpartum bleeding. After multivariate adjustment, only episiotomy (aOR 4.40, 95% CI 2.10-9.64) and intrapartum antibiotic administration (aOR 0.21, 95% CI 0.07-0.50) remained significantly associated with wound dehiscence.
CONCLUSIONS: Episiotomy substantially increased the risk of deep perineal wound dehiscence compared with spontaneous second-degree perineal tears, while intrapartum antibiotics were protective. These findings support selective episiotomy use and suggest that antibiotic prophylaxis may reduce this risk in women with second-degree perineal tears or episiotomies.
MATERIAL AND METHODS: A single-center case-control study (1:2 ratio) was conducted including 105 cases with 2nd degree perineal tears or episiotomies complicated by deep wound dehiscence, diagnosed within two weeks postpartum and 210 controls with second-degree tears or episiotomies without dehiscence. Exposure data were retrieved from medical records. Univariate analyses were performed on a priori selected exposure variables, using Mann-Whitney U and Fisher's exact tests. Variable selection used Lasso regression with leave-one-out cross-validation. Multivariate logistic regression generated adjusted odds ratios (aOR). Statistical significance was set at p < 0.05.
RESULTS: Women with wound dehiscence were more often vaginal primiparas (87% vs 69%, p < 0.001) and had higher rates of episiotomy (33% vs 7%, p < 0.001). Intrapartum antibiotics were administered less frequently among cases (7% vs 20%, p = 0.002). Cases had longer second stage of labor, more active pushing, and greater postpartum bleeding. After multivariate adjustment, only episiotomy (aOR 4.40, 95% CI 2.10-9.64) and intrapartum antibiotic administration (aOR 0.21, 95% CI 0.07-0.50) remained significantly associated with wound dehiscence.
CONCLUSIONS: Episiotomy substantially increased the risk of deep perineal wound dehiscence compared with spontaneous second-degree perineal tears, while intrapartum antibiotics were protective. These findings support selective episiotomy use and suggest that antibiotic prophylaxis may reduce this risk in women with second-degree perineal tears or episiotomies.