Severe perineal lacerations (SPL=3rd & 4th degree lacerations) are associated with increased complications such as blood loss, puerperal pain, wound disruption, infection risks, incontinence and dyspareunia. The objective of this study is to examine the influence of race and ethnicity on SPLs.
This is a retrospective cohort analysis of the 2013 CDC birth certificate data for primiparous, term (≥37 weeks) singleton pregnancies with birthweights over 2,499 grams who delivered vaginally. The incidence of SPLs was calculated by each 500 gm birthweight group for these racial/ethnic groups; Non-Hispanic White, Non-Hispanic Black, Hispanic, and Asians including Asian subgroups.
The study population included a total of 964,041 deliveries. The total incidence of SPLs was 2.31%. Asians had the highest incidence of SPLs (4.0%; 2,399/60,042) followed by non-Hispanic Whites (2.57%; 12,938/503,241), Hispanics (1.53%; 2,683/175,588), and non-Hispanic Blacks (1.33%; 1,503/113,254). Among the Asian subgroups, Asian Indians had the highest incidence of SPLs (5.39%; 859/15,939) followed by Vietnamese (3.99%; 199/4,983), Filipino (3.90%; 267/6,845), Chinese (3.27%; 514/15,700), Japanese (3.03%; 61/2,015), and Koreans (2.90%; 131/4,522). For each race and ethnicity, SPLs increased with increasing birthweights.
Asians, especially Asian Indians, have the highest risk of developing SPLs. Obstetricians should be aware of such risk, and consider performing maneuvers that may decrease the risk of developing SPLs such as perineal massage, perineal warm packs, and episiotomies.
Weill Cornell Medical College, New York, NY
Financial Disclosure: The authors did not report any potential conflicts of interest.