Skip to main content

Perineal laceration occurs in almost half of postpartum women in Brazil.

Special Week on Epidemiology and Health Services 2024

References

  1. AASHEIM, V., et al. Perineal techniques during the second stage of labor for reducing trauma. Cochrane Databe Syst Rev [online]. 2017, vol. 6, no. 6, CD006672 [viewed 10 April 2024]. https://doi.org/10.1002/14651858.cd006672.pub3 . Available from: https://pubmed.ncbi.nlm.nih.gov/28608597/
  2. AGUIAR, M., et al . Birth-related perineal trauma in low- and middle-income countries: a systematic review and meta-analysis. Maternity Child Health J . [online]. 2019, vol. 23, no. 8, pp. 1048-1070 [viewed 10 April 2024]. https://doi.org/10.1007/s10995-019-02732-5 . Available from: https://pubmed.ncbi.nlm.nih.gov/30915627/
  3. OKEAHIALAM, NA, SULTAN, AH and THAKAR, R. The prevention of perineal trauma during vaginal birth. Am J Obstet Gynecol . [online]. 2023, vol. 230, no. 3, S991-S1004 [viewed 10 April 2024]. https://doi.org/10.1016/j.ajog.2022.06.021 . Available from: https://www.ajog.org/article/S0002-9378(22)00464-1/fulltext
  4. World Health Organization. Positive childbirth experience [online]. Geneva: World Health Organization. 2018 [viewed 10 April 2024]. Available from: https://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf
Black and white photograph of a pregnant woman sitting with her belly exposed and her hands resting on it.

Alberto Madeiro, Associate Editor of Epidemiology and Health Services: SUS Journal (RESS), Professor at the State University of Piauí, Teresina, PI, Brazil.

Approximately 85% of pregnant women may experience some type of perineal trauma, and around one-third present with spontaneous perineal lacerations of mild to severe degree during vaginal delivery. This common event can have negative consequences for the quality of life and health of women, including chronic perineal pain, sexual dysfunction, pelvic organ prolapse, and fecal incontinence.

Despite the magnitude and severity of the problem, information on the occurrence of this event in Brazil is still scarce and comes from local studies. The article “Prevalence and factors associated with the perception of perineal laceration: a cross-sectional study with data from the ‘Born in Brazil’ Survey, 2011 and 2012 ,” published in the journal Epidemiology and Health Services (vol. 33, 2024), reports national data on spontaneous perineal laceration self-reported by study participants.

The research, conducted by Luciana Mamede and colleagues from the Oswaldo Cruz Foundation (Fiocruz)/Rio de Janeiro, analyzed data from 4,606 postpartum women who had vaginal deliveries in 266 public and private hospitals between 2011 and 2012, after excluding those who underwent episiotomy.

Image: Pexels .

Almost half (49.5%) of the participants self-reported experiencing spontaneous perineal laceration, with a higher prevalence among adolescents aged 12 to 19 years, first-time mothers, those who had excessive weight gain during pregnancy, and those who underwent the Kristeller maneuver.

The high frequency of reports of the Kristeller maneuver is noteworthy. The maneuver was advocated to shorten the expulsive phase of labor by applying strong pressure to the fundus of the uterus, but it has been contraindicated since 1996 due to the risk of fetal and maternal harm, particularly rib fractures, hemorrhages, and perineal injuries. Despite this, it remains a very frequent obstetric intervention and one of the expressions of disrespect and abuse during childbirth.

On the other hand, the prevalence of laceration was lower among those residing in the North and Northeast regions, those who had completed only elementary school, those who had given birth to a small-for-gestational-age newborn, and those with insufficient weight gain during pregnancy. Factors that commonly favor perineal trauma – such as prolonged second stage of labor, use of oxytocin, maternal position that hinders visualization of the perineum, and instrumental vaginal delivery – were not associated with laceration.

As the authors point out in the article, there is evidence suggesting that perineal protection measures can be implemented both prenatally and during labor. Since perineal trauma is one of the indicators of quality of childbirth care, protecting pregnant women and reducing perineal trauma should be a goal for all those committed to providing positive birth experiences.