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Licensed Unlicensed Requires Authentication Published by De Gruyter April 28, 2020

Birth tears after spontaneous and vacuum-assisted births with different vacuum cup systems – a retrospective cohort study

  • Martina Kreft EMAIL logo , Roland Zimmermann and Nina Kimmich ORCID logo



Birth tears are a common complication of vaginal childbirth. We aimed to evaluate the outcomes of birth tears first by comparing the mode of vaginal birth (VB) and then comparing different vacuum cups in instrumental VBs in order to better advise childbearing women and obstetrical professionals.


In a retrospective cohort study, we analyzed nulliparous and multiparous women with a singleton pregnancy in vertex presentation at ≥37 + 0 gestational weeks who gave birth vaginally at our tertiary care center between 06/2012 and 12/2016. We compared the distribution of tear types in spontaneous births (SBs) vs. vacuum-assisted VBs. We then compared the tear distribution in the vacuum group when using the Kiwi Omnicup or Bird’s anterior metal cup. Outcome parameters were the incidence and distribution of the different tear types dependent on the mode of delivery and type of vacuum cup.


A total of 4549 SBs and 907 VBs were analyzed. Birth tear distribution differed significantly between the birth modes. In 15.2% of women with an SB an episiotomy was performed vs. 58.5% in women with a VB. Any kind of perineal tear was seen in 45.7% after SB and in 32.7% after VB. High-grade obstetric anal sphincter injuries (OASIS) appeared in 1.1% after SB and in 3.1% after VB. No significant changes in tear distribution were found between the two different VB modes.


There were more episiotomies, vaginal tears and OASIS after VB than after SB. In contrast, there were more low-grade perineal and labial tears after SB. No significant differences were found between different vacuum cup systems, just a slight trend toward different tear patterns.

Corresponding author: Martina Kreft, MD, Division of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland, Tel.: 0041-44-255 1111

  1. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  2. Research funding: None declared.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The study has been complied with all relevant national regulations and in accordance to the Declaration of Helsinki regarding ethical conduct of research involving human subjects, and has been approved by the Ethical Board of the district (KEK-ZH-Nr.2016-02079).


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Received: 2019-12-30
Accepted: 2020-03-23
Published Online: 2020-04-28
Published in Print: 2020-07-28

©2020 Walter de Gruyter GmbH, Berlin/Boston

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