Risk factors for poor perineal outcome after operative vaginal delivery.

OBJECTIVE

Identify risk factors for poor perineal outcome after operative vaginal delivery.

STUDY

DESIGN

A retrospective cohort study was performed including operative vaginal deliveries during 2015 through 2016.

RESULTS

Of 529 operative vaginal deliveries, 79 (14.9%) had higher order perineal lacerations and 14 (2.7%) had a wound breakdown. The only significant risk factor for higher order lacerations was chorioamnionitis (aOR 2.2; 95% CI 1.09-4.44). Risk factors for perineal wound breakdown included episiotomy (5.2 vs. 1.2%; p < 0.01), type of operative delivery (5.5% after forceps vs. 1.4% after vacuum; p < 0.01) and postpartum narcotic use. Overall, 9.3% of those using narcotics subsequently had a perineal breakdown as compared to 0.7% (p < 0.01). Narcotic use postpartum remained strongly associated in multivariable logistic regression (aOR 21.29; 95% CI 5.43-83.47). Patients with forceps deliveries, episiotomy, and narcotic use had a 38% risk of breakdown.

CONCLUSION

Women at highest risk of perineal wound breakdown benefit from close follow-up.