TY - JOUR
T1 - Risk factors for severe perineal lacerations during childbirth
T2 - A systematic review and meta-analysis of cohort studies
AU - Hu, Yinchu
AU - Lu, Hong
AU - Huang, Qifang
AU - Ren, Lihua
AU - Wang, Na
AU - Huang, Jing
AU - Yang, Minghui
AU - Cao, Linlin
N1 - Publisher Copyright:
© 2022 John Wiley & Sons Ltd.
PY - 2023/7
Y1 - 2023/7
N2 - Aims and objectives: To evaluate and quantify the best available evidence regarding risk factors for severe perineal lacerations. Background: Many studies have evaluated the risk factors for severe perineal lacerations. However, the results of those studies are inconsistent, and meta-analysis which thoroughly evaluates the risk factors for severe perineal lacerations is still lacking. Design: Systematic review and meta-analysis of cohort studies based on the PRISMA guideline. Methods: PubMed, Embase, the Cochrane Library, CINAHL, ClinicalTrials.gov, CNKI, Wanfang Data, VIP and SinoMed were systematically searched for cohort studies reporting at least one risk factor for severe perineal lacerations from 1 January 2000 to 2 June 2021. Two reviewers independently conducted quality appraisal by NOS scale and extracted data. Data synthesis was conducted via RevMan 5.3 using a random-effects or fixed-effects model. Results: A total of 47 studies with 7,043,218 women were included. The results showed that prior caesarean delivery (OR: 1.46, 95% CI 1.12–1.92) and pre-pregnant underweight (OR: 1.31, 95% CI 1.22–1.41) significantly increased the risk of severe perineal lacerations. The results also demonstrated that episiotomy was protective against severe perineal lacerations in forceps delivery (OR: 0.56, 95% CI 0.42–0.74), but not spontaneous vaginal delivery (OR: 1.30, 95% CI 0.81–2.07) or vacuum delivery (OR: 0.76, 95% CI 0.45–1.28). Nulliparity, foetus in occipitoposterior or occipitotransverse position, and midline episiotomy were also independent risk factors for severe perineal lacerations. Conclusions: Severe perineal lacerations are associated with many factors, and evidence-based risk assessment tools are needed to guide the midwives and obstetricians to estimate women's risk of severe perineal lacerations. Relevance to clinical practice: This systematic review and meta-analysis identified some important risk factors for severe perineal lacerations, which provides comprehensive insights to guide the midwives to assess women's risk for severe perineal lacerations and take appropriate preventive measures to decrease the risk.
AB - Aims and objectives: To evaluate and quantify the best available evidence regarding risk factors for severe perineal lacerations. Background: Many studies have evaluated the risk factors for severe perineal lacerations. However, the results of those studies are inconsistent, and meta-analysis which thoroughly evaluates the risk factors for severe perineal lacerations is still lacking. Design: Systematic review and meta-analysis of cohort studies based on the PRISMA guideline. Methods: PubMed, Embase, the Cochrane Library, CINAHL, ClinicalTrials.gov, CNKI, Wanfang Data, VIP and SinoMed were systematically searched for cohort studies reporting at least one risk factor for severe perineal lacerations from 1 January 2000 to 2 June 2021. Two reviewers independently conducted quality appraisal by NOS scale and extracted data. Data synthesis was conducted via RevMan 5.3 using a random-effects or fixed-effects model. Results: A total of 47 studies with 7,043,218 women were included. The results showed that prior caesarean delivery (OR: 1.46, 95% CI 1.12–1.92) and pre-pregnant underweight (OR: 1.31, 95% CI 1.22–1.41) significantly increased the risk of severe perineal lacerations. The results also demonstrated that episiotomy was protective against severe perineal lacerations in forceps delivery (OR: 0.56, 95% CI 0.42–0.74), but not spontaneous vaginal delivery (OR: 1.30, 95% CI 0.81–2.07) or vacuum delivery (OR: 0.76, 95% CI 0.45–1.28). Nulliparity, foetus in occipitoposterior or occipitotransverse position, and midline episiotomy were also independent risk factors for severe perineal lacerations. Conclusions: Severe perineal lacerations are associated with many factors, and evidence-based risk assessment tools are needed to guide the midwives and obstetricians to estimate women's risk of severe perineal lacerations. Relevance to clinical practice: This systematic review and meta-analysis identified some important risk factors for severe perineal lacerations, which provides comprehensive insights to guide the midwives to assess women's risk for severe perineal lacerations and take appropriate preventive measures to decrease the risk.
KW - OASIs
KW - risk
KW - severe perineal lacerations
KW - vaginal birth after caesarean delivery
KW - VBAC
UR - http://www.scopus.com/inward/record.url?scp=85133375775&partnerID=8YFLogxK
U2 - 10.1111/jocn.16438
DO - 10.1111/jocn.16438
M3 - Review article
C2 - 35791260
AN - SCOPUS:85133375775
SN - 0962-1067
VL - 32
SP - 3248
EP - 3265
JO - Journal of Clinical Nursing
JF - Journal of Clinical Nursing
IS - 13-14
ER -