Perineal trauma in nulliparous women and its associated factors

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Rebeca Vieira dos Santos
Alianny Raphaely Rodrigues Pereira
Cláudia Regina Oliveira de Paiva Lima
Diego de Sousa Dantas
Caroline Wanderley Souto Ferreira


Introduction: Perineal trauma is an important complication for women after giving birth. Objective: To evaluate the prevalence of perineal trauma and its associated factors in nulliparous. Methods: A retrospective cohort study was carried out, through the analysis of the medical records of women with singleton pregnancy who achieved vaginal birth of a live infant, in 2017, in a maternity hospital. Data collection involved information about demographic, obstetric, and clinical data from nulliparous women, and infant birthweight. Univariate and multivariate logistic analyses were performed to verify the association of perineal trauma with the variables assessed, with significant variables remaining in the model (p<0.05), through a stepwise strategy. Results: A total of 326 medical records were analyzed. The percentage of perineal trauma was 60%. In the multivariate analysis, the use of oxytocin increased the chance of perineal trauma by 730%. In addition, the adoption of squatting position and hands and knees decreased the chances of perineal trauma by 81% and 97%, respectively, in comparison with those who adopted the lithotomy position, during the second stage labor. Conclusion: The rate of perineal laceration was high, but the severity was low. The use of oxytocin is associated with the presence of trauma and the squatting position and hands and knees, especially, have contributed to the protection of the perineum.


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Santos, R. V. dos, Pereira, A. R. R., Lima, C. R. O. de P., Dantas, D. de S., & Ferreira, C. W. S. (2021). Perineal trauma in nulliparous women and its associated factors. ABCS Health Sciences, 46, e021224.
Original Articles


1. Moore KL, Dalley AF, Agur AMR. Anatomia orientada para a clínica. 7 ed. Rio de Janeiro: Guanabara Koogan, 2014.

2. Russel JG. Moulding of the pelvic outlet. Obstet Gynaecol Br Commonw. 1969;76(9):817-20.

3. Mitie IN. The influence of maternal position on duration of the active phase of labor. Int J Gynaecol Obstet. 1974;12(5):181-3.

4. Kemp E, Kingswood CJ, Kibuka M, Thornton JG. Position in the second stage of labor for women with epidural anaesthesia. Cochrane Database Syst Rev. 2013;(1):CD008070.

5. Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin no. 198: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol. 2018;132(3):e87-102.

6. Riesco MLG, Costa ASC, Almeida SFS, Basile ALO, Oliveira SMJV. Episiotomia, laceração e integridade perineal em partos normais: análise de fatores associados. Rev Enferm UERJ. 2011;19(1):77-83.

7. Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Gestão e Incorporação de Tecnologias em Saúde. Diretrizes Nacionais de Assistência ao Parto Normal. Brasília: Ministério da Saúde, 2017.

8. Hals E, Oian P, Pirhonen T, Gissler M, Hjelle S, Nilsen EB, et al. A multicenter interventional program to reduce the incidence of anal sphincter tears. Obstet Gynecol. 2010;116(4):901-8.

9. Groutz A, Hasson J, Wengier A, Skornick-Rapaport A, Lessing JB, Gordon D. Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium. Am J Obstet Gynecol 2011;204(4):P347.e1-347.e4.

10. Francisco AA, Oliveira SMJV, Santos JO, Silva FMB. Avaliação e tratamento da dor perineal no pós-parto vaginal. Acta Paul Enferm. 2011;24(1):94-100.

11. Hidalgo LP, Hidalgo MM, Rodrigues BMA. Labor stimulation with oxytocin: effects on obstetrical and neonatal outcomes. Rev Latino-Am Enfermagem. 2016;(24):27-44.

12. Oliveira LB, Mattos DV, Matão MEL, Martins CA. Laceração perineal associada ao uso de ocitocina exógena. Rev Enferm UFPE. 2017;8(1):2273-8. https://10.5205/1981-8963-v11i6a23387p2273-2278-2017

13. Jonsson M. Induction of twin pregnancy and the risk of caesarean delivery: a cohort study. BMC Pregnancy Childbirth. 2015;15:136.

14. Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C. Maternal positions and mobility during first stage labor. Cochrane Database Syst Rev. 2009;(2):CD003934.

15. Gizzo S, Gangi S, Noventa M, Bacile V, Zambon A, Nardeli GB. Women’s choice of positions during labor: return to the past or a modern way to give birth? A cohort study in Italy. Biomed Res Int. 2014;2014:638093.

16. Calais GB. O períneo feminino e o parto. Elementos de anatomia e exercícios práticos. São Paulo: Manole, 2005.

17. Kapandiji IA. Fisiologia articular: Esquemas comentados de mecânica humana. 6 ed. Rio de Janeiro: Guanabara Koogan, 2009.

18. Freitas JMS, Narchi NZ, Fernandes RAQ. Práticas obstétricas em centro de parto normal intra-hospitalar realizadas por enfermeiras obstetras. Esc. Anna Nery. 2019;23(4):e20190112.

19. Lemos A. Fisioterapia obstétrica baseada em evidência. Rio de Janeiro: MedBook, 2014.

20. Lee DG, Hodges P. The pelvic girdle: an approach to the examination and treatment of the lumbopelvic-hip region. 3rd ed. United Kingdom: Churchill Livings-Tone, 2004.

21. Calais GB, Parés N. A pelve feminina e o parto. São Paulo: Manole, 2013.

22. Leal MC, Bittencourt SA, Esteves-Pereira AP, Ayres BVS, Silva LBRAA, Thomaz EBAF, et al. Avanços na assistência ao parto no Brasil: resultados preliminares de dois estudos avaliativos. Cad Saude Publica. 2019;35(7):e00223018.

23. Stenpheson R, O'Conner L. Obstetric and gynecological care in physical therapy. Second Ed. Slack, EUA: Slack, 2000.

24. Koyanagi A, Zhang J, Dagvador A, Hirayama F, Shibuya K, Souza JP, et al. Macrosomia in 23 developing countries: An analysis of a multicountry, facility-based, cross-sectional survey. Lancet. 2013;381(9865):476-83.

25. Gyurkovits Z, Kálló K, Bakki J, Katona M, Bitó T, Pál A, et al. Neonatal outcome of macrosomic infants: An analysis of a two-year period. Eur J Obstet Gynecol Reprod Biol. 2011;159(2):289-92.

26. Simic M, Cnattingius S, Petersson G, Anna Sandström A, Stephansson O. Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study. BMC Pregnancy Childbirth. 2017;17(1):72.

27. Smith LA, Price N, Simonite V, Burns EE. Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy Childbirth. 2013;13:59.

28. Althabe F, Belizan JM, Bergel E. Episiotomy rates in primiparous women in Latin American: hospital based descriptive study. BMJ. 2002;324(7343):945-46.

29. Amorim MM, Franca-Neto FA, Leal VM. Is it possible to never perfom episiotomy during vaginal delivery?. Obstet Gynecol. 2014;385.

30. Shahraki AD, Aram S, Pourkabirian S, Khodaee S, Choupannejad S. A comparison between early maternal and neonatal complications of restrictive episiotomy and routine episiotomy in primiparous vaginal delivery. J Res Med Sci. 2011;16(12):1583-9.

31. Loewenberg-Weisband Y, Grisaru-Granovsky S, Ioscovich A, Samueloff A, Calderon-Margalit R. Epidural analgesia and severe perineal tears: a literature review and large cohort study. J Matern Fetal Neonatal Med. 2014;27(18):1864-9.