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Epidural analgesia may be protective against third and fourth degree perineal trauma
  1. M MacDougall,
  2. J Waugh,
  3. D Morland
  1. Royal Victoria Infirmary, Newcastle upon Tyne, UK

Abstract

Background We postulate that epidural analgesia during labour may be protective against 3rd/4th degree perineal trauma by reducing an uncontrolled urge to push at the point of delivery.

Methods We retrospectively reviewed the data for all 18 229 consecutive vaginal deliveries in a tertiary obstetric unit in the North of England between January 2008 and December 2010 looking at 3rd/4th degree tear rates in those with and without an epidural, achieving a spontaneous or assisted vaginal delivery.

Results Following spontaneous vaginal delivery the risk of 3rd/4th degree tear was significantly lower in the epidural group than in the no-epidural group (37 (1.9%) of 1989 vs 230 (2.7%) of 8564; relative risk 0.70 (95%CI 0.49 to 0.98) p<0.05). Following assisted vaginal delivery the risk of 3rd/4th degree tear was again significantly lower in the epidural group than in the no-epidural group (80 (4.6%) of 1746 vs 81 (6.9%) of 1176; relative risk 0.68 (95%CI 0.50 to 0.92) p<0.05). In this group the fourth degree tear rate was also significantly lower in those receiving an epidural compared to those who did not (4 (0.23%) of 1746 vs 10 (0.85%) of 1176; relative risk 0.27 (95%CI 0.08 to 0.86) p<0.05. The overall risk of sustaining a 3rd/4th degree perineal tear in those with an epidural was not different to those with no epidural (117 (3.1%) of 3735 vs 311 (3.2%) of 9740; relative risk0.98 (95%CI 0.79 to 1.21) p>0.05.

Conclusion Despite the increased rates of assisted vaginal delivery associated with the epidural population, the reduced rates of 3rd/4th degree tear sustained at both spontaneous and assisted vaginal delivery by those receiving an epidural was sufficient to offset any rise that increased assisted delivery caused, supporting our hypothesis that epidural may be protective.

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