Epidural Analgesia and Severe Perineal Laceration – (03-18-03)



Epidural Analgesia and Severe Perineal Laceration.

While I’m never going to have a baby, I strongly question the rampant use of epidurals for pregnancy. They are accepted as safe with no effects on the baby and yet the evidence speaks otherwise. Ever heard those war stories of perineal damage leading to severe pain, painful intercourse and incontinence?

J Am Board Fam Pract 16(1):1-6, 2003 This study assessed whether epidural analgesia was an independent risk factor for severe perineal laceration. Methods: A retrospective cohort study analyzed 2,759 patients at St. Francis Regional Medical Center who had vertex, spontaneous or induced, singleton, live, vaginal deliveries of neonates of at least 36 weeks’ gestation. Patients with diabetes or severe cardiac disease were excluded. Outcomes measured were third- or fourth-degree perineal lacerations. Results: Overall rate of severe perineal laceration was 6.38% (n = 176). Epidural analgesia was given to 634 (22.98%) women. Among women who had epidural analgesia, 10.25% (65 of 634) had severe perineal lacerations compared with 5.22% (111 of 2,125) of the women who did not have epidural analgesia. After controlling for major variables in a logistic regression analysis, epidural analgesia remained a significant predictor of severe perineal injury (odds ratio [OR] = 1.528, 95% confidence interval [CI] = 1.092-2.137). When instrument use was included in the model, epidural analgesia was no longer a statistically significant, independent predictor of severe perineal injury. (OR = 1.287, 95% CI = 0.907-1.826). Instrument use was found to be a strong predictor of severe laceration (OR = 3.245, 95% CI = 2.162-4.869). A logistic regression model examining predictors of instrument use found that epidural analgesia does significantly predict instrument use (OR = 3.01, 95% CI = 2.225-4.075). Conclusion: Epidural analgesia is associated with an increase in severe perineal trauma as a result of an associated threefold increased risk of instrument use. Instrument use in vaginal delivery more than triples the risk of severe perineal laceration.

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.







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Category: Healthy Pregnancy and Women's Health
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