Kapus, Karmen, Kukovica, Iva, Frelih Fabjan, Anita, Lučovnik, Miha, Kapus, Karmen, Kukovica, Iva, Frelih Fabjan, Anita, and Lučovnik, Miha
Introduction: Effects of the birthing position on perineal trauma, which depend on local and regional midwifery/obstetric practices, such as application of manual perineal protection technique, episiotomy rates, operative delivery rates etc., have not yet been sufficiently researched. The aim of this study was to examine a potential association between birthing positions and the risk of perineal trauma in a Slovenian hospital.Methods: This retrospective cohort study included 625 women with singleton fetuses who delivered at the Jesenice General Hospital in 2021. We excluded premature deliveries, deliveries with a fetus in the pelvic or occipito-posterior insertion, vacuum extractions of the fetus, and episiotomies. Multiple logistic regression analysis was used to investigate whether the birthing position (supine (n=66), lateral (n=404), or other position (n=155)) was independently associated with perineal trauma.Results: In the majority of women included in the study (n=363, or 58%), no perineal trauma occurred. First-degree perineal tear was present in 192 women (73%), second-degree in 59 women (23%) and third- or fourth-degree in 11 women (4%). The birthing position was not significantly associated with perineal trauma (odds ratio (OR) 0.691; 95% confidence interval (CI) 0.401–1.191 for the lateral position, and OR 0.710; 95% CI 0.386–1.306 for other positions compared with the supine position).Discussion and conclusion: In a Slovenian maternity unit with a high percentage of women delivering in "flexible sacrum positions", the birthing position at delivery was not found to be an independent risk factor for perineal trauma., Uvod: Vpliv porodnega položaja na tveganje za poškodbo presredka, ki je odvisen od lokalnih in regionalnih babiških praks, kot so ročna tehnika zaščite presredka, razne stopnje epiziotomije in operativnih porodov itd., še ni zadostno raziskan. Namen raziskave je bil v eni od slovenskih porodnišnic preučiti morebitno povezavo med porodnim položajem ob iztisu ploda in pojavnostjo poškodbe presredka.Metode: V retrospektivno kohortno raziskavo smo vključili 625 porodnic, ki so leta 2021 rodile v Splošni bolnišnici Jesenice. Izključili smo večplodne nosečnosti, prezgodnje porode, porode s plodom v medenični ali okcipito-posteriorni vstavi, vakuumske ekstrakcije ploda in epiziotomije. Z multiplo logistično regresijo smo preučili, ali je bil položaj porodnice ob iztisu ploda (leže na hrbtu (n = 66), leže na boku (n = 404) ali vsi ostali položaji (n = 155)) neodvisno povezan s pojavnostjo poškodbe presredka.Rezultati:Pri 363 porodnicah (58 %) ni prišlo do poškodbe presredka. Pri 192 (73 %) je prišlo do poškodbe prve stopnje, pri 59 (23 %) do poškodbe druge stopnje in pri 11 (4 %) do poškodbe presredka tretje ali četrte stopnje. Porodni položaj ob iztisu ploda ob upoštevanju drugih potencialnih dejavnikov tveganja ni bil statistično pomembno povezan s tveganjem za poškodbo presredka: razmerje obetov (RO) 0,691, 95% interval zaupanja (IZ) – 0,401–1,191 za položaj na boku; RO 0,710, 95% IZ – 0,386–1,306 za ostale položaje v primerjavi s porajanjem leže na hrbtu.Diskusija in zaključek: V slovenski porodnišnici z visokim odstotkom porodnic, ki ne rodijo leže na hrbtu, porodni položaj ob iztisu ploda ni neodvisni dejavnik tveganja za nastanek poškodbe presredka