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Risk factors for severe perineal lacerations: a case-control study
GYNECOLOGY
A Comparison of Outcomes of Transurethral Versus Suprapubic Catheterization After Burch Cystourethropexy Terry S. Dunn, MD Denver Health Medical Center, Denver, CO
Risk Factors for Severe Perineal Lacerations: A Case-Control Study Terry S. Dunn, MD Denver Health Medical Center, Denver, CO
Debra Guinn, MD, My-Linh Pham, MD, and Doug Wolf, PhD
Johanna Figge, MD, and Doug M. Wolf, PhD
OBJECTIVE: To identify potentially modifiable risk factors for third and fourth degree lacerations at a training hospital.
OBJECTIVE: To evaluate the outcomes of patients with transurethral versus suprapubic catheterization after Burch cystourethropexy.
STUDY DESIGN: A retrospective case-control study of 177 women with third and fourth degree lacerations and 177 controls. Cases were identified using ICD-9 codes between January 1, 2000 and June 21, 2001. Corresponding controls were identified in our perinatal database and were matched for vaginal delivery and birth weight (⫹300 g). Logistic modeling was performed in SPSS.
METHODS: This is a retrospective cohort study of patients who had a Burch procedure alone, and vaginal hysterectomy and Burch between July 1997 and June 2002. Abstracted data included age, race, parity, weight, use of hormone replacement therapy, tobacco use, preexisting medical conditions, and indication for surgery. The variables analyzed were change in hematocrit, length of hospital stay, length of catheterization, postoperative fever, and urinary tract infection. The total numbers of postoperative visits including emergency visits and complications within each group were compared. Analysis was done using SAS 8.1 with Fisher exact test and Wilcoxon rank-sum analysis when indicated. RESULTS: Two hundred patients’ charts were analyzed. There were no significant differences between the groups with regard to age, weight, parity, and menopausal status. The outcomes of surgery (ie, blood loss, postoperative morbidity, incidence of urinary tract infection, length of hospital stay, and number of visits postoperatively both to the clinic and to the emergency room) in each group did not statistically differ. There was a significant difference in length of catheterization: 7.1 days for the transurethral group and 9.61 days for the suprapubic, a 1.79-day difference (P ⫽ .001).
RESULTS: The cases and controls had similar ages, gestational ages, and birth weights. On univariate analysis the following variables were associated with severe lacerations: nulliparity, induction, large for gestational age (LGA), episiotomy, prolonged second stage, and persistent OP or OT presentations. Episiotomy was performed in 47/354 women. In women undergoing operative vaginal delivery, episiotomy appeared to be protective in reducing severe perineal lacerations (11/31 [36%] versus 82/144 [54%], P ⬍ .001). In contrast, episiotomy was associated with increased lacerations in women undergoing spontaneous delivery (20/31 [64%] versus 62/144 [36%], P ⬍ .001). Long-term follow-up was poor in both groups of women. CONCLUSIONS: Significant factors associated with severe perineal trauma include nulliparity, LGA, and operative vaginal delivery. The only potentially modifiable condition is operative delivery. Selective use of episiotomy appeared to be protective in women undergoing operative delivery.
CONCLUSIONS: There is no difference in outcomes whether a transurethral or suprapubic catheter was used. There was a significant difference in length of catheterization. This may be accounted for by two reasons: clinic scheduling and patients’ reports of discomfort, thus shortening the length of catheterization in the transurethral group.
28S
MONDAY POSTERS
OBSTETRICS & GYNECOLOGY
A Comparison of Outcomes of Transurethral Versus Suprapubic Catheterization After Burch Cystourethropexy Terry S. Dunn, MD Denver Health Medical Center, Denver, CO
Risk Factors for Severe Perineal Lacerations: A Case-Control Study Terry S. Dunn, MD Denver Health Medical Center, Denver, CO
Debra Guinn, MD, My-Linh Pham, MD, and Doug Wolf, PhD
Johanna Figge, MD, and Doug M. Wolf, PhD
OBJECTIVE: To identify potentially modifiable risk factors for third and fourth degree lacerations at a training hospital.
OBJECTIVE: To evaluate the outcomes of patients with transurethral versus suprapubic catheterization after Burch cystourethropexy.
STUDY DESIGN: A retrospective case-control study of 177 women with third and fourth degree lacerations and 177 controls. Cases were identified using ICD-9 codes between January 1, 2000 and June 21, 2001. Corresponding controls were identified in our perinatal database and were matched for vaginal delivery and birth weight (⫹300 g). Logistic modeling was performed in SPSS.
METHODS: This is a retrospective cohort study of patients who had a Burch procedure alone, and vaginal hysterectomy and Burch between July 1997 and June 2002. Abstracted data included age, race, parity, weight, use of hormone replacement therapy, tobacco use, preexisting medical conditions, and indication for surgery. The variables analyzed were change in hematocrit, length of hospital stay, length of catheterization, postoperative fever, and urinary tract infection. The total numbers of postoperative visits including emergency visits and complications within each group were compared. Analysis was done using SAS 8.1 with Fisher exact test and Wilcoxon rank-sum analysis when indicated. RESULTS: Two hundred patients’ charts were analyzed. There were no significant differences between the groups with regard to age, weight, parity, and menopausal status. The outcomes of surgery (ie, blood loss, postoperative morbidity, incidence of urinary tract infection, length of hospital stay, and number of visits postoperatively both to the clinic and to the emergency room) in each group did not statistically differ. There was a significant difference in length of catheterization: 7.1 days for the transurethral group and 9.61 days for the suprapubic, a 1.79-day difference (P ⫽ .001).
RESULTS: The cases and controls had similar ages, gestational ages, and birth weights. On univariate analysis the following variables were associated with severe lacerations: nulliparity, induction, large for gestational age (LGA), episiotomy, prolonged second stage, and persistent OP or OT presentations. Episiotomy was performed in 47/354 women. In women undergoing operative vaginal delivery, episiotomy appeared to be protective in reducing severe perineal lacerations (11/31 [36%] versus 82/144 [54%], P ⬍ .001). In contrast, episiotomy was associated with increased lacerations in women undergoing spontaneous delivery (20/31 [64%] versus 62/144 [36%], P ⬍ .001). Long-term follow-up was poor in both groups of women. CONCLUSIONS: Significant factors associated with severe perineal trauma include nulliparity, LGA, and operative vaginal delivery. The only potentially modifiable condition is operative delivery. Selective use of episiotomy appeared to be protective in women undergoing operative delivery.
CONCLUSIONS: There is no difference in outcomes whether a transurethral or suprapubic catheter was used. There was a significant difference in length of catheterization. This may be accounted for by two reasons: clinic scheduling and patients’ reports of discomfort, thus shortening the length of catheterization in the transurethral group.
28S
MONDAY POSTERS
OBSTETRICS & GYNECOLOGY