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Predictors of Third- and Fourth-Degree Lacerations in Forceps-Assisted Delivery: A Case–Control Study

INTRODUCTION: The objective of this study was to develop a model for predicting perineal lacerations in women attempting forceps-assisted delivery. METHODS: We identified all forceps-assisted deliveries at our institution from January 1, 2002 to June 30, 2012. Multiple gestations were excluded. The laceration group included third and fourth degree was compared with a control group including a random sample of women who had a forceps-assisted delivery without lacerations. Regression models were used to develop the best model for predicting perineal lacerations associated with forceps-assisted delivery. RESULTS: Out of a total of 17,111 vaginal deliveries, 794 (4.6%) had a forceps-assisted delivery. After exclusions, 769 women were included. Of those, 146 (19.0%) had lacerations. The laceration group was significantly older, had more primiparas, more pregnancy greater than 40 weeks of gestation, more forceps-assisted delivery for arrest, longer second stage, more occipitoposterior position, and less use of episiotomy (Table 1). The following were independent predictors in the final model: age younger than 30 years, pregnancy greater than 40 weeks of gestation, primiparous, occipitoposterior position, and absence of episiotomy with adjusted odds ratio of 2.4 (95% confidence interval [CI] 1.4–4.2), 1.9 (95% CI 1.2–3.1), 3.6 (95% CI 1.9–7.3), 2.0 (95% CI 1.0–3.9), and 2.2 (95% CI 1.3–3.7), respectively. The final model had a range of predicted probabilities (11–90%) (Fig. 1). Table 1 Baseline Characteristics (Gill, p. 145–6S) Fig. 1. Receiver operator characteristic curve for final model for predicting risk of perineal laceration during forceps-assisted delivery. (Gill, p. 145–6S) CONCLUSION: We present a model that can accurately stratify patient risk for laceration during forceps-assisted delivery.