Striae Gravidarum as a Predictor of Vaginal Lacerations at Delivery

Andrea J. Wahman, MD, Michael A. Finan, MD, S. Cameron Emerson, MD, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, La

South Med J. 2000;93(9) 

In This Article

Abstract and Introduction

Background. Abdominal stretch marks found during pregnancy may be indicative of poor skin elasticity. One who does not have stretch marks may have better skin elasticity and may be less likely to tear perineal and vaginal tissue during vaginal delivery. This study was conducted to determine whether striae gravidarum could predict lacerations and their severity.
Methods. This prospective observational study included 168 women having vaginal delivery of infants who weighed more than 2,000 g. The absence or presence and degree of lacerations involving the perineum, vagina, labia, and periurethral regions were studied with a step-wise multivariate logistic regression analysis.
Results. Episiotomy was found to prevent spontaneous lacerations. Abdominal stretch marks were found to be statistically significant predictors of lacerations when controlling for episiotomy.
Conclusions. Patients with striae gravidarum are at higher risk for lacerations at the time of vaginal delivery than patients who do not have abdominal stretch marks.

In light of the present medical data supporting popular culture's disrespect for the elective episiotomy, many obstetricians are attempting to decrease their episiotomy rate. Anecdotally, we have noted that women with few stretch marks had more stretchable perineal skin and were less likely to experience lacerations on delivery. To help physicians decide who needs an episiotomy, we undertook a prospective observational study to determine whether there are predictors of which patients will have lacerations without an episiotomy, or extensions to third or fourth degree if an episiotomy is done. Of particular interest was whether the mother had abdominal stretch marks and their extent. This study tests the theory that one who does not have stretch marks has good skin elasticity and is less likely to tear her tissue at the birth of her infant.

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