Prevalencia y factores asociados a la percepción de laceración perineal: estudio transversal con datos de la Encuesta Nascer no Brasil, 2011 y 2012

Mamede, Luciana; Marano, Daniele; Dias, Marcos Augusto Bastos; Souza Junior, Paulo Roberto Borges de

doi:10.1590/S2237-96222024V33E2023621.EN

Luciana Mamede

concept and design

analysis and interpretation

reviewing and drafting

integrity

Fundação Oswaldo Cruz, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Programa de Pós Graduação em Saúde da Mulher e da Criança. Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0001-8964-1725

Daniele Marano

concept

analysis and interpretation

drafting

integrity

Fundação Oswaldo Cruz, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0001-6985-941X

Marcos Augusto Bastos Dias

interpretation

reviewing

integrity

Fundação Oswaldo Cruz, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0003-1386-7001

Paulo Roberto Borges de Souza Junior

analysis and interpretation

integrity

Fundação Oswaldo Cruz, Instituto de Informação e Comunicação Científica e Tecnológica da Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0002-8142-4790

Correspondence: Luciana Mamede. E-mail: mamede2010@gmail.com

AUTHOR CONTRIBUTIONS

Mamede L contributed to the study concept and design, data analysis and interpretation, critically reviewing the intellectual content and drafting the article. Marano D contributed to the study concept, data analysis and interpretation, critically reviewing the intellectual content, drafting the article and final approval of the version to be published. Dias MAB contributed to data interpretation, critically reviewing the intellectual content and final approval of the version to be published. Junior PRBS contributed to both the statistical analysis and interpretation of the data. All the authors have approved the final version of the manuscript and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

CONFLICTS OF INTEREST

The authors declare they have no conflicts of interest.

Associate editor: Alberto Madeiro - https://orcid.org/0000-0002-5258-5982

Variables	n^a	%
Maternal age (years)
12-19	831	19.0
20-34	3,315	71.5
35 or over	459	9.5
Region of residence
North	743	12.8
Northeast	1,538	33.3
Southeast	1,325	39.7
South	681	9.7
Midwest	319	4.6
Race/skin color
White	1,112	24.7
Black	478	11.0
Mixed race	3,014	64.3
Maternal schooling
Incomplete elementary education	1,967	40.3
Complete elementary/incomplete high school education	1,265	29.2
Complete high school education	1,268	28.6
Complete higher education and above	106	1.9
Weight at birth per gestational age
Small for gestational age	367	7.9
Appropriate for gestational age	3,606	79.8
Large for gestational age	619	12.3
Fetal presentation
Cephalic	4,121	99.0
Breech	39	1.1
Adequacy of gestational weight gain
Insufficient	1,538	32.6
Adequate	1,490	32.7
Excessive	1,578	34.7
Pre-gestational nutritional status
Low weight	428	9.1
Normal weight	2,780	61.2
Overweight	1,028	22.1
Obesity	370	7.6
Parity
Primipara	1,108	27.1
Multipara	3,498	73,0
Induced labor
No	3,989	85.4
Yes	617	14.6
Position of the parturient during the expulsion period
Horizontal	4,782	89.3
Vertical	575	10.7
Use of analgesic/anesthetic
No	4,374	96.4
Yes	163	3.6
Kristeller Maneuver
No	3,411	75.7
Yes	1,195	24.3
Instrumental delivery
No	4,551	99.0
Yes	55	1.0

Variables	Perineal laceration
	No	Yes	PR^a	95%CI^b
	n (%)	n (%)
Distal level
Maternal age (years)
12-19	407 (15.0)	615 (23.3)	1.27	1.12;1.43
20-34	2,009 (74.0)	1,815 (68.7)	1.00	‒^c
35 or over	298 (11.0)	210 (8.0)	0.87	0.75;1.01
Region of residence
North	456 (16.8)	236 (8.9)	0.59	0.45;0.76
Northeast	968 (36.3)	791 (30.0)	0.76	0.66;0.88
Southeast	897 (33.0)	1,226 (48.5)	1.00	‒^c
South	268 (9.9)	255 (9.7)	0.84	0.73;0.97
Midwest	111 (4.1)	131 (5.0)	0.93	0.78;1.10
Race/skin color
White	563 (20.7)	734 (27.8)	1.00	‒^c
Black	311 (11.4)	268 (10.2)	0.81	0.70;0.95
Mixed race	1,784 (65.7)	1,598 (60.6)	0.83	0.76;0.90
Maternal schooling
Incomplete elementary education	1,341 (49.3)	821 (31.1)	0.56	0.47;0.69
Complete elementary/incomplete high school education	750 (27.6)	817 (30.9)	0.78	0.65;0.93
Complete high school education	592 (21.8)	933 (35.3)	0.91	0.76;1.09
Complete higher education and above	35 (1.3)	69 (2.6)	1.00	‒^c
Intermediate level
Weight at birth per gestational age
Small for gestational age	258 (9.5)	160 (6.1)	0.75	0.61;0.92
Appropriate for gestational age	2,112 (78.0)	2,159 (81.8)	1.00	‒^c
Large for gestational age	337 (12.4	320 (12.1)	0.96	0.83;1.11
Fetal presentation
Cephalic	2,430 (98.3)	2,409 (99.6)	1.00	‒^c
Breech	42 (1.7)	10 (0.4)	0.40	0.17;0.90
Pre-gestational nutritional status
Low weight	230 (8.5)	257 (9.7)	1.03	0.89;1.20
Normal weight	1,640 (60.3)	1,646 (62.4)	1.00	‒^c
Overweight	630 (23.2)	543 (20.6)	0.91	0.82;1.01
Obesity	219 (8.0)	194 (7.3)	0.91	0.78;1.07
Adequacy of gestational weight gain
Insufficient	965 (35.5)	776 (29.4)	0.89	0.80;0.99
Adequate	890 (32.7)	867 (32.8)	1.00	‒^c
Excessive	863 (31.7)	997 (37.8)	1.20	1.08;1.33
Parity
Primipara	448 (16.5)	1,005 (38.1)	3.21	2.40;4.30
Multipara	2,270 (83.5)	1,635 (61.9)	1.00	‒^c
Proximal level
Induced labor
No	2,362 (86.9)	2,214 (83.9)	1.00	‒^c
Yes	355 (13.1)	426 (16.1)	1.13	1.02;1.25
Position of the parturient in the expulsion stage
Horizontal	2,427 (89.3)	2,355 (89.2)	1.00	‒^c
Vertical	290 (10.7)	285 (10.8)	1.10	0.71;1.71
Use of analgesic/anesthetic
No	2,604 (97.3)	2,494 (95.3)	1.00	‒^c
Yes	72 (2.7)	122 (4.7)	1.30	1.07;1.58
Kristeller Maneuver
No	2,168 (79.8)	1,891 (71.6)	1.00	‒^c
Yes	550 (20.2)	748 (28.4)	1.22	1.10;1.36
Instrumental delivery forceps/vacuum cup
No	2,705 (99.5)	2,598 (98.4)	1.00	‒^c
Yes	12 (0.5)	41 (1.6)	0.62	0.52;075

	Model 1 Distal variables		Model 2 Distal and intermediate variables		Model 3 Distal, intermediate and proximal variables
Variables	PR^a	95%CI^b	PR^a	95%CI^b	PR^a	95%CI^b
Maternal age (years)
12-19	1.36	1.22;1.51	1.14	1.02;1.27	1.12	1.02;1.25
20-34	1.00	‒	1.00	‒	1.00	‒
35 or over	0.91	0.79;1.04	0.98	0.84;1.14	1.00	0.86;1.16
Race/skin color
White	1.00	‒	1.00	‒	1.00	‒
Black	0.90	0.78;1.03	0.89	0.78;1.01	0.89	0.78;1.01
Mixed race	0.94	0.86;1.02	0.93	0.84;1.03	0.93	0.85;1.03
Region of residence
North	0.64	0.51;0.81	0.67	0.54;0.83	0.67	0.52;0.81
Northeast	0.86	0.75;0.98	0.87	0.77;0.99	0.87	0.74;0.95
Southeast	1.00	‒	1.00	‒	1.00	‒
South	0.87	0.77;0.99	0.89	0.78;1.02	0.90	0.78;1.03
Midwest	0.96	0.82;1.12	1.03	0.87;1.21	0.99	0.85;1.16
Maternal schooling
Incomplete elementary education	0.57	0.47;0.70	0.68	0.56;0.84	0.67	0.55;0.83
Complete elementary education	0.73	0.61;0.88	0.86	0.71;1.05	0.89	0.73;1.09
Complete high school education	0.88	0.73;1.07	0.96	0.80;1.16	1.00	0.82;1.22
Complete higher education and above	1.00	‒	1.00	‒	1.00	‒
Weight at birth per gestational age
Small for gestational age			0.76	0.62;0.93	0.77	0.64;0.93
Appropriate for gestational age	‒	‒	1.00	‒	1.00	‒
Large for gestational age			1.13	0.97;1.30	1.11	0.96;1.28
Fetal presentation
Cephalic	‒	‒	1.00	‒	1.00	‒
Breech			0.50	0.23;1.09	0.50	0.21;1.20
Adequacy of gestational weight gain
Insufficient			0.89	0.81;0.97	0.88	0.81;0.96
Adequate	‒	‒	1.00	‒	1.00	‒
Excessive			1.18	1.07;1.31	1.17	1.07;1.29
Parity
Primipara			1.50	1.36;1.65	1.47	1.33;1.63
Multipara	‒	‒	1.00	‒	1.00	‒
Induced labor
No	‒	‒	‒	‒	1.00	‒
Yes					0.94	0.85;1.04
Parturient position during the expulsion period
Horizontal	‒	‒	‒	‒	1.00	‒
Vertical					1.02	0.86;1.21
Use of analgesic and anesthetic
No	‒	‒	‒	‒	1.00	‒
Yes					1.02	0.86;1.22
Kristeller Maneuver
No	‒	‒	‒	‒	1.00	‒
Yes					1.18	1.08;1.30
Instrumental delivery forceps/vacuum cup
No	‒	‒	‒	‒	1.00	‒
Yes					1.14	0,93;1,39

[TFN1] a) n: Unweighted sample size.

Prevalencia y factores asociados a la percepción de laceración perineal: estudio transversal con datos de la Encuesta Nascer no Brasil, 2011 y 2012

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