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Master Thesis

Risk factors of obstetrics third and fourth degree perineal tears: a systematic review

Abstract : Background: Third and fourth degree tears occur in 0.5 to 8% of vaginal birth, reaching 25% for some authors. Perineal traumas are often associated to chronic pain, dyspareunia, sexual dissatisfaction and urinary and faecal incontinence. The objective of this review is to identify the risk factors of 3rd and 4th degree perineal traumas during vaginal birth. Method: We searched MEDLINE, Sciencedirect, EBSCO Pascal, OvidSP, BDSP, Opengrey and Google Scholar. All trial exploring risk factors of 3rd and 4th degree (RCOG) or 2nd and 3rd (CNGOF) perineal trauma were explored. We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. One review author evaluated methodological quality, using a quality assessment scale. Results: The most important risk factors of third and fourth perineal tears are instrumental deliveries, both forceps and vacuum, nulliparity, Asian ethnicity, shoulder dystocia, increase of birth weight and occipito-posterior presentations. Results are discordant concerning episiotomy, epidural analgesia and duration of second stage of labour. Gestational age, maternal age, labour induction and augmentation are not risk-factors for perineal lacerations. Conclusion: A careful management of birth, including reducing instrumental deliveries, a restrictive use of medio-lateral episiotomy and a reduction of occipito-posterior presentations to occipito-anterior should be performed in at risk population. A prevention of foetal weight increase should also be done. Several tools - such as scores, perineal massages and warm compresses have shown efficiency to predict and reduce perineal tears and should be generalized.
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Contributor : Jean-Hugues Morneau <>
Submitted on : Monday, July 20, 2015 - 9:18:38 AM
Last modification on : Tuesday, May 11, 2021 - 11:36:16 AM
Long-term archiving on: : Wednesday, October 21, 2015 - 5:00:20 PM


  • HAL Id : dumas-01176318, version 1


Élie Goudon. Risk factors of obstetrics third and fourth degree perineal tears: a systematic review. Gynecology and obstetrics. 2015. ⟨dumas-01176318⟩



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