Prediction of perineal tear during childbirth by assessment of striae gravidarum score
Keywords:Striae gravidarum, Perineal tear, Episiotomy
Background: The objective of this study was to explore the association between striae gravidarum and the risk for perineal tear during childbirth.
Methods: Three hundred patients delivered normally were included in this study. Striae gravidarum score was assessed using the Atwal numerical scoring system. The association was examined between striae and perineal tear as the outcome measure, defined by tears or laceration, and the total striae scores (TSS) was obtained.
Results: Mean age was 25.41 years ranging from 20 - 30 years, mean gravidity was 2.27 ranging from 1 - 5, mean weight gain was 9.72 Kg ranging from 5 - 16 Kgs and average baby birth weight was 2.8 Kg ranging from 2.1 - 3.5 Kg. The only predictors of perineal tears that were found to be statistically significant in our study were Severity of striae gravidarum and Episiotomy given or not. In patients with moderate to severe striae there was tear in 105 patients as compared to 45 patients with no or mild striae. 89 patients belonging to no or mild striae group delivered without any perineal tear whereas 61 patients in moderate to severe striae group delivered without perineal tear. It is observed that episiotomy has some protective effect against perineal tear.
Conclusions: This study demonstrates a significant relation between severity of striae gravidarum and perineal tear. The findings suggest that striae gravidarum assessment may be used in the clinical setting even by paramedical staff as a simple and noninvasive tool to better define women at risk for perineal tear.
Arkin AE, Chern-Hughes B. Case report: Labial fusion postpartum and clinical management of labial lacerations. Journal of Midwifery and Women’s Health. 2002;47:290-2.
Andrews V, Thakar R, Sultan AH, Jones PW. Evaluation of postpartum perineal pain and dyspareunia: a prospective study. Eur J Obstet Gynecol Reprod Biol. 2008;137:152-6.
Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Systematic Review. 2009;21(1):cd000081.
Alves GF, Nogueira LS, Varella TC. Dermatology and pregnancy. Anias Brasilieros de Dermatologia. 2005;80:179-86.
Chang AL, Agrenado YZ, Kimball AB. Risk factors associated with striae gravidarum. Journal of the American Academy of Dermatology. 2004;51:881-5.
Osman H, Rubeiz N, Tamim H, Nassar AH. Risk factors for the development of striae gravidarum. American Journal of Obstetrics and Gynecology. 2007;62:1-5.
Atwal GS, Manku LK, Griffiths CE, Polson DW. Striae gravidarum in primiparae. Br J Dermatol. 2006;155:965-9.
Angioli R, Gomez-Matin O, Cantuaria G, O’Sullivan MJ. Severe perineal lacerations during vaginal delivery: the University of Miami experience. Am J Obstet Gynecol. 2000;182:1083-5.
Klein MC, Gauthier RJ, Jorgensen SH, Robbins JM, Kaczorowski J, Johnson B, Corriveau M, Westreich R, Waghorn K, Gelfand MM, et al. Does episiotomy prevent perineal trauma and pelvic floor relaxation? Online J Curr Clin Trials. 1992 Jul;Doc No 10:[6019 words; 65 paragraphs].
Helwig JT, Thorp JM Jr, Bowes WA Jr. Does midline episiotomy increase the risk of third- and fourth-degree lacerations in operative vaginal deliveries? Obstet Gynecol. 1993 Aug;82(2):276-9.
Thorp JM Jr, Bowes WA Jr, Brame RG, et al. Selective use of midline episiotomy: effect on perineal trauma. Obstet Gynecol. 1987;70:240-4.
Gass MS, Dunn C, Stys SJ. Effect of episiotomy on the frequency of vaginal outlet lacerations. J Reprod Med. 1986 Apr;31(4):240-4.
Borghi J, Fox-Rushby J, Bergel E, Abalos E, Hutton G, Carroli G. The cost-effectiveness of routine versus restrictive episiotomy in Argentina. Am J Obstet Gynecol. 2002 Feb;186(2):221-8.