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Risk factors for anal sphincter tears: the importance of maternal position at birth

  1. K Gottvall1,*,
  2. P Allebeck2,
  3. C Ekéus1

Article first published online: 12 SEP 2007

DOI: 10.1111/j.1471-0528.2007.01482.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 114, Issue 10, pages 1266–1272, October 2007

Additional Information

How to Cite

Gottvall, K., Allebeck, P. and Ekéus, C. (2007), Risk factors for anal sphincter tears: the importance of maternal position at birth. BJOG: An International Journal of Obstetrics & Gynaecology, 114: 1266–1272. doi: 10.1111/j.1471-0528.2007.01482.x

Author Information

  1. 1

    Department of Women and Child Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden

  2. 2

    Department of Social Medicine and Epidemiology, Centre for Public Health, Stockholm County Council, Stockholm, Sweden

*Dr K Gottvall, Department of Women and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Retzius väg 13 A-B, SE-171 77 Stockholm, Sweden. Email karin.gottvall@ki.se

Publication History

  1. Issue published online: 12 SEP 2007
  2. Article first published online: 12 SEP 2007
  3. Accepted 28 June 2007.

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Keywords:

  • Anal sphincter tears;
  • birth position;
  • delivery;
  • lithotomy;
  • vaginal birth

Objective  To assess the role of birth position in the occurrence of anal sphincter tears (AST).

Design  Observational cohort study.

Setting  South Hospital in Stockholm, a teaching hospital with around 5700 births per year.

Population  Among all 19 151 women who gave birth at the South Hospital during the study period 2002–05, 12 782 women met the inclusion criteria of noninstrumental, vaginal deliveries.

Methods  Data on birth position and other obstetric factors were analysed in relation to occurrence of AST.

Main outcome measure  Third- and fourth-degree AST.

Results  AST occurred in 449 women (3.5%). The trauma was more frequent in primiparous (5.8%) than in multiparous women (1.7%). The highest proportion of AST was found among women who gave birth in lithotomy position (6.9%), followed by squatting position (6.4%). Logistic regression analyses showed that lithotomy (adjusted OR 2.02, 95% CI 1.58–2.59) and squatting positions (adjusted OR 2.05, 95% CI 1.09–3.82) were associated with a significantly increased risk for AST. Other major risk factors for anal sphincter trauma were primiparity (adjusted OR 3.29, 95% CI 2.55–4.25), prolonged second stage of labour >1 hour (adjusted OR 1.52, 95% CI 1.11–2.10), infant birthweight more than 4 kg (adjusted OR 2.12, 95% CI 1.64–2.72) and large infant head circumference (adjusted OR 1.57, 95% CI 1.23–1.99).

Conclusion  Lithotomy and squatting position at birth were associated with an increased risk for AST also after control for other risk factors.

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