Atwal Striae Gravidarum Score for Prediction of Perineal Tears During Vaginal Delivery: A Cross- Sectional Study

Objective: To evaluate the value of Atwal striae gravidarum (SG) score for prediction of occurrence of perineal tears (PT) during vaginal delivery.

Methods: A cross-sectional study conducted between October 2016 and April 2018 included all multiparous women presented in the active phase of labor. Assessment of SG score was done using Atwal score in the abdomen, hips, breasts and buttocks. According to the total striae score (TSS) women were classified into two groups; group (I): mild SG (TSS ≤12) and group (II) moderate/severe SG (TSS >12). The primary study outcome was the rate of PT in both groups.

Results: The study included 421 women; 188 in group I and 233 in group II. The rate of PT was significantly higher in group II than group I (56.2% vs. 3.2% respectively, p<0.001). Additionally, para-urethral, vaginal and cervical tears were more common in group II (p=0.029, 0.025 and 0.047 respectively). Additionally, we found significantly higher TSS among women with PT versus those without PT (17.07±3.56 vs. 7.93±6.94, p <0.001). Multivariate regression analysis revealed that the presence of abdominal striae and the TSS >12 were associated with increased risk of PT.

Conclusion: Assessment of Atwal SG score could precisely predict the occurrence of PT in multiparous women during vaginal delivery.

Keywords: Striae gravidarum; Perineal tears; Vaginal delivery; Atwal score