Third- and fourth-degree perineal tears: Prevalence and risk factors in the third millennium

Objective: We sought to assess the modern prevalence and risk factors for third- and fourth-degree perineal tears. Study Design: The study population comprised 38,252 women who delivered in one medical center, from January 2005 through December 2009, and met the following inclusion criteria: singleton pregnancy, vertex presentation, and vaginal delivery. Of these, 96 women (0.25%) sustained third- or fourth-degree perineal tears. Maternal and obstetric variables were compared between women with vs without severe perineal tears. Results: Five variables were found to be statistically significant independent risk factors: Asian ethnicity (odds ratio [OR], 8.9; 95% confidence interval [CI], 4.218.9), primiparity (OR, 2.4; 95% CI, 1.53.7), persistent occipito posterior (OR, 2.1; 95% CI, 14.5), vacuum delivery (OR, 2.7; 95% CI, 1.64.6), and heavier birthweight (OR, 1.001; 95% CI, 11.001). Conclusion: Severe perineal tears are uncommon in modern obstetric practice. Significant risk factors are Asian ethnicity, primiparity, persistent occipito posterior, vacuum delivery, and heavier birthweight.