Anita Sit

Racial/ethnic variations in perineal length and association with perineal lacerations: a prospective cohort study.

Abstract Objective: To examine the association between race/ethnicity, perineal length and the risk of perineal laceration. Methods: This is a prospective cohort study of a diverse group of women with singleton gestations in the third trimester of pregnancy. Perineal length was measured and mean values calculated for several racial/ethnic groups. Chi-squared analyses were used to examine rates of severe perineal laceration (third or fourth degree laceration) by race/ethnicity among women considered to have a short perineal length. Further, subgroup analyses were performed comparing nulliparas to multiparas. Results: Among 344 study participants, there was no statistically significant difference in mean perineal length by race/ethnicity (White 4.0 ± 1.1 cm, African-American 3.7 ± 1.0 cm, Latina 4.1 ± 1.1 cm, Asian 3.8 ± 1.0 cm, and other/unknown 4.0 ± 0.9 cm). Considering parity, more multiparous Asian and African-American women had a short perineal length (20.7 and 23.5%, respectively, p = 0.05). Finally, the rate of severe perineal lacerations in our cohort was 2.6% overall, but was 8.2% among Asian women (p = 0.04). Conclusions: We did not find a relationship between short perineal length and risk of severe perineal laceration with vaginal delivery, or a difference in mean perineal length by maternal race/ethnicity. However, we did find that women of different racial/ethnic groups have varying rates of severe perineal laceration, with Asian women comprising the highest proportion.

Maternal Height Compared With Body Mass Index as a Predictor of Trial of Labor After Cesarean Delivery Success [155]

INTRODUCTION: There is evidence to support maternal height as a predictive factor for successful vaginal delivery with shorter women at increased risk of cesarean delivery. The purpose of this study is to examine maternal height compared with body mass index (BMI, calculated as weight (kg)/[height (m)]2) as predictors of trial of labor after cesarean delivery (TOLAC) success. METHODS: We performed a retrospective case–control analysis comparing successful vaginal delivery and failed TOLAC. Women attempting TOLAC over a 2-year period (2010–2012) were eligible for the study (n=580). Multivariable analyses were performed to determine the predictive ability of height+BMI on TOLAC success compared with BMI alone. RESULTS: Body mass index was a statistically significant predictor of TOLAC success (BMI 31.6 compared with 33.3, P<.01). There was an association between increased height and TOLAC success (62.1 compared with 61.4 inches, P=.01). When comparing height+BMI with BMI alone, the ability to predict TOLAC success was the same for both groups (odds ratio 0.95, 95% confidence interval 0.92–0.98). There were some demographic differences between the groups including gestational age (38.7 compared with 39.3 weeks of gestation, P<.01), parity (one compared with two, P<.01), and birth weight (3,382 compared with 3,477 g, P<.01). No significant confounding variables were observed. CONCLUSION: In our population, there was a significant decrease in TOLAC success for every increase in unit of BMI. There was a clinically insignificant difference in maternal height between women with successful and unsuccessful TOLAC. In multivariable models, maternal height did not significantly affect this association; thus, consideration of maternal height in addition to BMI was not a better predictor of TOLAC success than BMI alone.