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Severe laceration related to race, perineal length: Asian Americans have twice the risk. (Study of 34,048 Women).

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 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 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 in a multivariate analysis. The greatest risk factor was an episiotomy, which tripled the risk for a severe tear in patients as a whole.

Among multiparous women, those with an episiotomy were seven times more likely to have a severe tear than those who did not undergo the procedure. The use of forceps tripled the risk in women overall and quadrupled the risk in multiparous women.

A previous retrospective study of approximately 2 million deliveries found that Filipino and Asian Indian women were more likely than others to have severe tears. Another study of operative vaginal deliveries found a 30% increased risk of severe laceration in Asians.

In a poster presentation at the meeting, 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, he said. As a result of his findings, Dr. Deering 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.

In the study, the perineal body was measured from the posterior fourchette of the vagina to the midanus. The average perineal body length in the first stage of labor was 4 cm. Forty percent of women with a perineum shorter than 3 cm developed third- or fourth-degree lacerations, compared with 6% of women with a longer perineum, said Dr. Deering of Georgetown University, Washington.

The increased risk conveyed by a shorter perineum remained after controlling for operative vaginal delivery, use of episiotomy, and fetal weight. Operative vaginal deliveries occurred at a higher rate in women with a perineum of 3.5 cm or less than in women with longer perineums (28% vs. 9%).
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Author:Boschert, Sherry
Publication:OB GYN News
Date:Jul 1, 2002
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