The association between the number of vaginal examinations during labor and perineal trauma: a retrospective cohort study

• Published in: Archives of gynecology and obstetrics Vol. 301; no. 6; pp. 1405 - 1410
• Main Authors: Gluck, Ohad, Ganer Herman, Hadas, Tal, Ori, Grinstein, Ehud, Bar, Jacob, Kovo, Michal, Ginath, Shimon, Weiner, Eran
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2020; Springer Nature B.V
• Subjects: Adult; Cesarean section; Cohort analysis; Cohort Studies; Endocrinology; Epidural; Episiotomy; Female; Gynecological Examination - adverse effects; Gynecology; Human Genetics; Humans; Maternal-Fetal Medicine; Medicine; Medicine & Public Health; Midwifery; Obstetric Labor Complications - etiology; Obstetrics; Obstetrics/Perinatology/Midwifery; Perineum - injuries; Pregnancy; Retrospective Studies; Trauma; Vagina; Perineal trauma; Obstetric anal sphincter injury; Vaginal examination
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-020-05552-z

Purpose To study the association between the number of vaginal examinations (VEs) performed during labor and subsequent severe perineal trauma. Methods This is a retrospective cohort study. We included all women admitted to the delivery ward between 2008 and 2017, in active labor. Exclusion criteria included preterm deliveries (< 37 weeks), Cesarean deliveries and episiotomy during delivery. The primary outcome, severe perineal trauma, was defined as perineal tears grades 3–4. The cohort was divided into 4 groups, based on the number of VEs performed during labor: Group 1—up to two VEs ( n  = 4588), Group 2—three to four VEs ( n  = 5815), Group 3—five to six VEs ( n  = 4687), and Group 4—seven or more VEs ( n  = 7297). Results Overall, 22,387 women were included in the study. The rate of severe perineal trauma in groups 1, 2, 3 and 4 was 0.4%, 0.1%, 0.8%, and 0.4%, respectively ( p  < 0.001). Performing five or more VEs during labor was associated with a higher risk of severe perineal trauma (0.26% vs. 0.53%, p  < 0.01), as compared to four VEs or less. Using a logistic regression model, we found that performing five or more VEs during labor (aOR = 1.72 CI 95% (1.21–2.47), p  < 0.001) or performing an instrumental delivery (aOR = 2.65 CI 95% (1.72–4.07), p  < 0.001) were directly associated with the risk for severe perineal trauma. Applying epidural anesthesia showed an inverse association with severe perineal trauma (aOR = 0.54 CI 95% (0.38–0.77), p  < 0.001). Conclusion Performing five or more VEs during active labor is associated with an increased risk for severe perineal trauma.