Breakdown of perineal laceration repair after vaginal delivery

Abstract

Objective The aim of the study was to estimate risk factors associated with breakdown of perineal laceration repair after vaginal delivery. Methods This is a case-control study of women who sustained a breakdown of perineal laceration repair after vaginal delivery between 2002 and 2015. Cases were patients who sustained a perineal wound breakdown after vaginal delivery and repair of a second-, third-, or fourth-degree laceration. Controls, matched 1:1, were patients who either sustained a second-, third-, or fourth-degree perineal laceration and repair without evidence of breakdown and who delivered on the same day and institution as the case. Results A total of 104,301 deliveries were assessed for breakdown of perineal laceration. One hundred forty-four met the inclusion criteria. These were matched with 144 controls. Logistic regression analysis demonstrated that smoking is associated with increased risk for breakdown of perineal laceration (adjusted odds ratio [adj. OR], 6.4; 95% confidence interval [CI], 1.2–38.5), whereas a previous vaginal delivery is protective (adj. OR, 0.14; 95% CI, 0.05-0.3). In addition, third- or fourth-degree laceration (adj. OR, 4.0; 95% CI, 1.1–15.7), presence of episiotomy at time of delivery (adj. OR, 11.1; 95% CI, 2.9–48.8), operative delivery (adj. OR, 3.4; 95% CI, 1.2–10.3), midwife performing the laceration repair (adj. OR, 4.7; 95% CI, 1.5–15.8), and use of chromic suture (adj. OR, 3.9; 95% CI, 1.6–9.8) were independent risk factors for breakdown of perineal laceration. Conclusions Smoking, nulliparity, episiotomy, operative delivery, third- or fourth-degree laceration, repair by a midwife, and use of chromic suture are independent risk factors for breakdown of perineal laceration repair after vaginal delivery.