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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 12 May 2004
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Obstetric anal sphincter lacerations. Obstet Gynecol. 2001 Aug;98(2):225-30.

Author(s) :

Handa VL, Danielsen BH, Gilbert WM.

Year of publication :


URL(s) :…

Résumé (français)  :

Abstract (English)  :

OBJECTIVE: To estimate the frequency of obstetric anal sphincter laceration and to identify characteristics associated with this complication, including modifiable risk factors.

METHODS: A population-based, retrospective study of over 2 million vaginal deliveries at California hospitals was performed, using information from birth certificates and discharge summaries for 1992 through 1997. We excluded preterm births, stillbirths, breech deliveries, and multiple gestations. The main outcome measure was obstetric anal sphincter laceration (third and fourth degree).

RESULTS: The frequency of anal sphincter lacerations was 5.85% (95% confidence interval [CI] 5.82, 5.88), decreasing significantly from 6.35% (95% CI 6.27, 6.43) in 1992 to 5.43% (95% CI 5.35, 5.51) in 1997 (P <.01). Using logistic regression analysis, we identified primiparity as the dominant risk factor (odds ratio [OR] for women with prior vaginal birth 0.15; 95% CI 0.14, 0.15). Birth weight over 4000 g was also highly significant (OR 2.17; 95% CI 2.07, 2.27). Lacerations occurred more often among women of certain racial and ethnic groups: Indian women (OR 2.5; 95% CI 2.23, 2.79) and Filipina women (OR 1.63; 95% CI 1.50, 1.77) were at highest risk. Episiotomy decreased the likelihood of third-degree lacerations (OR 0.81; 95% CI 0.78, 0.85), but increased the risk of fourth-degree lacerations (OR 1.12; 95% CI 1.05, 1.19). Operative delivery increased the risk of sphincter laceration, with vacuum delivery (OR 2.30; 95% CI 2.21, 2.40) presenting a greater risk than forceps delivery (OR 1.45; 95% CI 1.37, 1.52).

CONCLUSION: Anal sphincter lacerations are strongly associated with primiparity, macrosomia, and operative vaginal delivery. Of the modifiable risk factors, operative vaginal delivery remains the dominant independent variable.

Sumário (português)  :

Comments :

Argument (français) :

L’extraction instrumentale est une des principales causes indépendantes des déchirures du sphyncter anal. L’épisiotomie diminue le taux des déchirures du 3e degré, mais elle augmente dans les mêmes proportions ce lui des déchirures du 4e degré. (Etude rétrospective de 2 millions de cas)

Argument (English):

Argumento (português):

Keywords :

➡ perineal/vaginal tears ; episiotomy ; instrumental delivery ; forceps delivery ; vacuum extraction (ventouse)

Author of this record :

Cécile Loup — 12 May 2004

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