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Race, perineal length may impact risk of severe lacerations. (Exacerbated By Episiotomy, Forceps).

Los ANGELES -- Third-and fourth-degree lacerations during delivery are more likely to happen in Asian American women and women with a shortened perineal body, two separate studies concluded.

Rates of severe laceration rates in Asian Americans were more than double those of women of other races in a retrospective analysis of 34,048 deliveries during a 7-year period, Dr. Jay Goldberg reported at the annual meeting of the American College of Obstetricians and Gynecologists.

The study included vaginal, forceps-assisted, and vacuum-assisted deliveries to 833 Asian Americans, 13,759 whites, 16,956 blacks, and 392 Hispanic Americans.

Among those who did not have an episiotomy, 9% of Asians, 4% of whites, 3% of Hispanics, and 2% of black mothers suffered severe tears, said Dr. Goldberg of Jefferson Medical College, Philadelphia.

In women who had an episiotomy and in multiparous women, black race was no longer protective, and Asian race still carried an increased risk of a severe tear. With an episiotomy, 32% of Asians, 19% of blacks, 17% of Hispanics, and 15% of whites developed severe lacerations.

Among 8,358 multiparous patients with or without episiotomy, the risk of a severe tear was doubled in Asian women, compared with any of the other races.

Other well-known factors also increased the risk of a severe tear. The greatest risk factor was an episiotomy, which tripled the risk for a severe tear in patients as a whole. The use of forceps also tripled the risk. In a previous retrospective study of about 2 million deliveries in California, Filipino and Asian Indian women were more likely than others to suffer severe tears.

In a poster presentation, Dr. Shad H. Deering reported that women with a perineal body shorter than 3 cm had more than six times as many severe lacerations as did women with longer perineums in a retrospective study of 131 deliveries.

The idea that a shorter perineum would be more likely to tear is "intuitive" but had not been studied before, Dr. Deering said.

As a result of his findings, he now pays more attention to the possibility of severe laceration in women with a short perineum. When he performs an episiotomy in such women, he is more likely to do a mediolateral incision than a midline incision in the hope that it will lower their risk of a severe tear. A larger, prospective trial is underway to test that hypothesis, he added.

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Comment:Race, perineal length may impact risk of severe lacerations. (Exacerbated By Episiotomy, Forceps).
Author:Boschert, Sherry
Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1USA
Date:Jul 1, 2002
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