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   Table of Contents      
REVIEW ARTICLE
Year : 2022  |  Volume : 27  |  Issue : 5  |  Page : 363-369

The relationship between perineal trauma and striae gravidarum: A systematic review and meta-analysis


1 MSc in Midwifery, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
2 Assistant Professor of Reproductive Health, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Biostatistics, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran

Date of Submission05-Dec-2020
Date of Decision05-Jan-2021
Date of Acceptance20-Feb-2022
Date of Web Publication14-Sep-2022

Correspondence Address:
Samira Ebrahimzadeh Zagami
Ebne-Sina Street, School of Nursing and Midwifery, Mashhad
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnmr.IJNMR_379_20

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  Abstract 


Background: Perineal trauma is a common problem seen after vaginal delivery, which has negative effects on different aspects of women's lives. Poor skin elasticity has been introduced as a predictor of perineal trauma, and the appearance of striae gravidarum is associated with poor skin elasticity. This review aimed to determine the association between perineal trauma and striae gravidarum through a systematic review and meta-analysis. Materials and Methods: We searched with MeSH terms (“Perineum” AND “Lacerations” OR “Rupture” AND “Striae Distensae”) and their equivalents in databases PubMed, Scopus, Science direct, Web of Science, ProQuest, Scientific Information Database (SID), Magiran, and Google Scholar search engine without time and language restrictions from the beginning of May until the beginning of September 2020. After reviewing the inclusion and exclusion criteria, and quality evaluation, ten articles were included in the systematic review, and we analyzed data of 6 articles using Stata ver 11.2. Results: The results indicated that the rate and severity of perineal trauma were directly related to the severity of striae gravidarum (OR = 8.28, 95%CI = 2.49–27.54, I2 = 86.64%). Conclusions: Based on the research results, the probability of perineal trauma was higher in individuals with moderate to severe striae than those with mild or without striae; therefore, we suggest evaluating striae score in the third trimester of pregnancy as a simple and noninvasive method to predict the risk of perineal trauma during childbirth. For reducing perineal injuries in women at risk, some supportive measures such as episiotomy and perineal massage are recommended.

Keywords: Delivery, meta-analysis, perineum, striae distensae


How to cite this article:
khamseh FK, Zagami SE, Ghavami V. The relationship between perineal trauma and striae gravidarum: A systematic review and meta-analysis. Iranian J Nursing Midwifery Res 2022;27:363-9

How to cite this URL:
khamseh FK, Zagami SE, Ghavami V. The relationship between perineal trauma and striae gravidarum: A systematic review and meta-analysis. Iranian J Nursing Midwifery Res [serial online] 2022 [cited 2022 Oct 2];27:363-9. Available from: https://www.ijnmrjournal.net/text.asp?2022/27/5/363/356042




  Introduction Top


Perineal trauma is a common problem seen after vaginal delivery. Due to its complications in severe cases, it has negative effects on the physical, psychological, and social aspects of women's lives.[1] The prevalence of perineal laceration was 79.8% in the study by Lins et al.[2] (2019) in Brazil. In the study by Abedzadeh et al.[3] (2019) in Iran, it was reported to be 84.3%. Ruptures can occur spontaneously or by episiotomy.[4] Spontaneous ruptures vary from minor mucosal damages to severe injuries of the perineal and rectal muscles, ranging from grades 1 to 4.[4],[5] Perineal trauma, especially in severe cases are along with short-term and long-term complications such as infection,[6] dyspareunia,[7] urinary problems,[8],[9] anal sphincter injury,[10] rectovaginal fistula,[11] and fecal incontinence,[8] that affect women's health and quality of life. The risk factors for perineal trauma include primiparity,[2],[12] Asian race,[12],[13],[14] white women,[13] short perineal length,[15] operative vaginal delivery,[4],[12],[16] high birth weight,[4],[17] higher maternal age,[17] epidural analgesia,[12] and shoulder dystocia.[14]

Despite paying attention to these risk factors and performing various clinical interventions to minimize perineal trauma during childbirth, there is a low ability to predict the risk of perineal trauma, and perineal damages continue during childbirth,[18] which is a major concern for women.[19] According to studies, the number of women who tend to have elective cesarean delivery due to perineal damages or unpleasant experiences in previous deliveries is increasing.[19] Therefore, better identification of women at the risk of perineal trauma is essential to improve the outcomes of vaginal birth.[1] Striae gravidarum, which usually occurs after 24 weeks of gestation[20] and in more than 70% of pregnant women,[21] is considered reddish and slightly depressed streaks that are common on the skin of the abdomen and sometimes on the skin of breasts and thighs.[5] These lines increase in the third trimester[21] and are a sign of poor skin elasticity.[1],[22] The etiology of striae gravidarum is unknown, but the combined effect of hormonal factors and skin stretching plays a key role in creating these lines.[21] Other factors such as low maternal age,[21],[23] excessive weight gain during pregnancy,[21],[23] sex of baby,[21] birth weight,[21],[24],[25] family history of striae gravidarum,[23],[24],[25] and socioeconomic status[21] are effective in causing the striae gravidarum. Poor skin elasticity has also been introduced as a predictor of perineal trauma,[1] and the occurrence of striae in pregnancy is associated with poor skin elasticity.[26] Striae gravidarum indicates the skin's ability to stretch and amounts of elastic fibers and collagen within it[27] and is caused by changes in connective tissue, and a decrease in amounts of elastin and fibrillin in the skin[24],[25] is along with the influence of hormonal factors.[21],[28],[29] Numerous studies have investigated the relationship between the occurrence of striae gravidarum and an increase in perineal damages.[1],[22],[26],[28],[30],[31]

Evaluation of striae gravidarum can be performed by staffs without any need for special equipment and invasive methods through a simple observation, based on Atwal and Davey tools.[1] If women at risk of perineal tears are identified, some preventive methods can be used to reduce these injuries.[32],[33],[34] Therefore, due to a high rate of perineal damages and negative effects of these injuries on various aspects of women's lives and similar mechanism of perineal trauma and striae gravidarum (poor skin elasticity), we performed the present systematic review and meta-analysis to investigate the relationship between perineal trauma and striae gravidarum.


  Materials and Methods Top


The present systematic review study was based on the proposed checklist of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).[35] We searched with MeSH terms (“Perineum” AND “Lacerations” OR “Rupture” AND “Striae Distensae”) and also the title and abstract of the studies were searched for ([”perineal trauma” OR “perineal laceration” OR “perineal tear” OR “perineal damage” OR “perineal rupture” OR “perineal injury”] AND [”striae gravidarum” OR “stretch marks” OR “Striae Distensae”]) in databases, PubMed, Scopus, Science direct, Web of Science, ProQuest, Scientific Information Database (SID), Magiran, and Google Scholar search engine during the time periods covered by the related databases from the beginning of May until the beginning of September 2020 without time and language restrictions. Articles' references were also sought for further studies.

The main inclusion criteria in the present study were studies that examined the relationship between perineal trauma and striae gravidarum. Review articles, duplicate articles, letter to the editor-in-chief, case report, and thesis were also excluded from study. The study selection process is shown in the PRISMA flowchart [Figure 1]. According to the reported results by the available studies, three different scenarios were considered for meta-analysis. In the first scenario, the odds of perineal trauma was assessed in women with moderate to severe striae in comparison to those with mild or without striae.[22],[28],[36] In the second scenario, the odds of perineal trauma occurrence was analyzed with increase in Striae Score.[1],[30] In the third scenario, the odds of perineal trauma was calculated in individuals with moderate to severe striae by comparison with those with mild striae [Table 1], [Table 2].[30],[31]
Figure 1: PRISMA flow chart of the study

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Table 1: Characteristics of studies included in the systematic review (2000-2019)

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Table 2: Pooled risk estimates for perineal trauma and heterogeneity analysis

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To calculate the striae score based on Davey tool, the abdomen is divided into four parts using the midline and horizontal line through the umbilicus, and the number of striae in each section is calculated separately. Each section is given a score of 0 (no striae), 1 (moderate striae), and 2 (many striae) based on the number of striae. The total score varies from 0 to 8. The severity of striae is divided into three categories without striae (0), mild striae (1 to 2), and severe striae (3 to 8) (Yamaguchi as quoted by Buchanan).[37] In order to calculate the striae score based on Atwal instrument, the skin of 4 areas of the body (abdomen, thighs, breasts, and buttocks) is evaluated in terms of color and number of striae and 6 scores are assigned to each area; Total Striae Score (TSS) is the sum of striae scores based on Atwal instrument and it can be ranged from 0–24 and interpreted as follows: 0–3 (no striae), 4–9 (mild striae), 10–15 (moderate striae), and more than 15 (severe striae).[21]

We evaluated the reporting quality of articles imported in the systematical review using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.[38] The STROBE checklist consists of six general sections: title and abstract, introduction, methods, results, discussion, and other information. Some of these titles are divided into other subsets that include a total of 22 items. In order to score the checklist, score 1 was given if any item was mentioned in the evaluation process, otherwise score 0 was considered, and the score ranged from 0–22 based on the checklist. Articles, which scored less than 6 in cross-sectional studies and less than 7 in cohort studies, were considered as low quality articles.[39] In order to evaluate the quality of article reporting, the full text of articles entered into the research was evaluated independently by two researchers (F.K. and S.E.) and discussed with the third researcher (V.G.) in the case of disagreement. Data extracted from the articles included the first author, year, place of study, study design, sample size, scale, results, and quality score [Table 1].

Odds ratios with 95% CI were used to assess the association of perineal trauma and striae gravidarum. When available, adjusted OR were selected over crude measures. Presence of statistical heterogeneity between studies was assessed using Q statistic with a significant level of p < 0.1. When heterogeneity between studies was not significant p > 0.1), a fixed-effect model was used to pool the data; otherwise, the DerSimonian and Laird random-effects model was applied.[40] To quantify the proportion of between-study variations attributable to heterogeneity, an I2 statistic was calculated. All analyses were performed using Stata version 11.2 (Stata Crop, college station, Texas).

Ethical considerations

The authors are committed to avoiding from redundant publication and plagiarism. Results that were not statistically significant were expressed and discussed without bias.


  Results Top


A total of 10 studies with a sample size of 3084 were reviewed, of which 6 studies were capable of meta-analysis; [1],[22],[28],[30],[31],[36] the studies were conducted from 2000 to 2019. The research population consisted of primiparous and multiparous women in eight studies, but the primiparous women alone in a study by Bhujabal et al.,[41] and multiparous women alone in a study by Abbas et al.[31] In two studies, Davey instrument was used[18],[26] to evaluate the severity of striae gravidarum, and Atwal instrument in another 8 studies.[1],[22],[27],[28],[30],[31],[36],[41] the number of striae was examined in the latent phase of the first stage of labor and up to two days after delivery, and perineal trauma was reported based on grades one to four and in some studies as mild trauma (grades 1 and 2), and severe trauma (grades 3 and 4).[27],[28] [Table 1] presents the characteristics of studies included in the systematic review.

A meta-analysis of three studies by Kapadia et al., Khrisnamurti et al., and Patel et al.[22],[28],[36] (the first scenario) indicated that the striae gravidarum was associated with perineal trauma so that the odds of perineal trauma was 8.28 times more in those with moderate to severe striae comparing to those without and mild striae (OR = 8.28, 95%CI = 2.49–27.54, I2 = 86.64%). In the meta-analysis of two studies by Halperin et al. and Banu et al.[1],[30] (the second scenario), the striae gravidarum was associated with perineal trauma and the odds of having higher striae score was 1.04 times more in those with perineal trauma comparing to those without perineal trauma (OR = 1.04, 95%CI = 1.02–1.06, I2 = 0.08%). Similarly in the meta-analysis of two studies by Abbas et al. and Banu et al.[30],[31] (the third scenario), perineal trauma was 13.77 times more in those with moderate to severe striae comparing to individuals with mild striae (OR = 13.77, 95%CI = 1.87-101.49, I2 = 92.89%) [Table 2].

Wahman et al.[26] (2000) introduced the striae gravidarum as a predictor for perineal trauma (p < 0.001), and the moderate or severe striae was associated with a higher risk of perineal trauma. It was also reported that episiotomy was associated with a lower rate of perineal trauma (p < 0.001). In the study by Sereshti et al.[18] (2013), the prevalence of striae gravidarum was 82.8%. In this study, the severity of striae gravidarum was higher in women with perineal trauma than a group without perineal trauma. There was also a significant relationship between breast striae gravidarum score and perineal ruptures during childbirth, and women with more striae on the breast were more likely to suffer perineal and vaginal tears (p = 0.021).

In the study by Halperin et al.[27] (2017), who examined the relationship between striae gravidarum and severe perineal trauma, there was no statistically significant relationship between the severity of striae gravidarum and anal sphincter injury (p = 0.2), but there was a significant relationship between the severity of striae gravidarum and severity of anal sphincter injury (p = 0.025) so that TSS was higher in individuals with grades 3c and 4 perineal trauma compared to those with grade 3a and 3b trauma. In the study by Bhujabal et al.[41] (2019), the mean score of striae gravidarum was higher among women with perineal trauma than women without perineal trauma and the relationship was clinically significant, but not statistically significant (p = 0.634). It is also reported that episiotomy was associated with a reduction in the perineal trauma (p < 0.001).


  Discussion Top


In the present systematic review and meta-analysis, which aimed to investigate the relationship between perineal trauma and striae gravidarum, we reviewed nine studies with cross-sectional design and a study with cohort design. The results indicated that the rate and severity of perineal trauma were directly related to the severity of striae gravidarum so that with increasing TSS, the degree of perineal rupture and its prevalence increases and the rate of perineal trauma was higher in individuals with moderate to severe striae than those with mild striae or without striae. Results of this meta-analysis and two studies by Sereshti et al. (2013)[18] and Wahman et al. (2000)[26] in the systematic review also confirmed the relationship between perineal trauma and striae gravidarum.

Bhujabal et al.[41] (2019) examined the relationship between striae gravidarum and perineal trauma in primiparous women and the relationship was clinically significant, but not statistically significant, which is probably due to the fact that the research population consisted of primiparous pregnant women. In the study by Halperin et al.[27] (2017), who examined the relationship between the severity of striae gravidarum and severe perineal trauma (grades 3 and 4), the relationship was not significant, which may be due to the fact that the anal sphincter injury was associated with many factors; and striae gravidarum, which indicated the amount of collagen, was one of those factors. In their study, 80 individuals with severe perineal trauma were examined for striae gravidarum, but if they examined the severe perineal trauma in those with and without striae, the relationship could be significant. In this study, there was a significant relationship between severity of striae gravidarum and severity of anal sphincter injury (p = 0.025), which is consistent with other studies in this systematic review and meta-analysis.

In the study by Omidi et al.[42] (2018), who examined the relationship between severity of striae gravidarum and premature rupture of membranes, it was reported that there was a relationship between severity of striae gravidarum and premature rupture of membranes, and the number of individuals with severe striae and premature rupture of membranes was higher than those with mild to moderate striae. Results obtained in this study were consistent with the present study probably due to the common mechanism of striae gravidarum formation, perineal trauma, and premature rupture of membranes.

Kurt et al. (2014)[43] and Mirrane et al. (2019),[44] who examined the association between striae and pelvic organ prolapse, reported striae as a predictor of pelvic organ prolapse, and individuals with prolapse of the pelvic organs were more likely to have striae than those without prolapse. Vulic et al.[45] (2011) also reported a reduction in collagen expression in the uterosacral ligament of individuals with pelvic organ prolapse. The consistency of the results of the above three studies with the results of this systematic review and meta-analysis was probably due to the similar physiopathology (reduction of tissue elasticity) of striae formation, pelvic organ prolapse, and perineal trauma.

Cakir Gungor et al.[46] (2014) conducted a study with an aim to determine the predictive value of striae gravidarum on intra-peritoneal adhesions and uterine scar thickness in women with a previous cesarean section. The results indicated that intraperitoneal adhesions and uterine scar thickness were higher in individuals with severe striae than those with mild or no striae. The consistency of these results with the results of this systematic review and meta-analysis was due to changes in elastin and collagen in individuals with striae[24] and the protective effect of elastin on intra-peritoneal adhesions.[47]

The present study was the first systematic review and meta-analysis of the association between perineal trauma and striae gravidarum. In the present study, there was no linguistic and time limit, and we searched our keywords in various databases and thus it was tried to examine all the articles in this field. The research limitations included different methods of reporting the results and tools in the studies included in the systematic review, which did not allow the meta-analysis of every ten articles included in the systematic review. Also, among the six studies which were meta-analyzed, three studies were statistically analyzed together and another three studies were analyzed in two binary reviews due to different populations and different reported results as mentioned in the “materials and methods” and “results” sections of the present study.


  Conclusion Top


The research results indicated that increasing Total Striae Score (TSS) enhanced the risk of perineal trauma. The probability of perineal trauma was higher in individuals with moderate to severe striae than those with mild or without striae. This association is due to the similar mechanism of perineal trauma and striae gravidarum, which is poor skin elasticity. Therefore, we suggest evaluating TSS in the third trimester of pregnancy as a simple and noninvasive method to predict the risk of perineal trauma during vaginal delivery. After identification of women at risk of perineal tears, some supportive measures such as episiotomy, perineal massage before delivery and during the second stage of labor as well as using warm compress during the second stage of labor are recommended to reduce these injuries.

Acknowledgements

The present article was from a project approved by the Research Council of the Research Center of Mashhad Faculty of Nursing and Midwifery with a registration code 990086. We are grateful to the authors of the articles used in this systematic review and meta-analysis.

Financial support and sponsorship

Mashhad University of Medical Sciences

Conflicts of interest

Nothing to declare.



 
  References Top

1.
Halperin O, Raz I, Ben-Gal L, Or-Chen K, Granot M. Prediction of perineal trauma during childbirth by assessment of striae gravidarum score. J Obstet Gynecol Neonatal Nurs 2010;39:292-7.  Back to cited text no. 1
    
2.
Lins VML, Katz L, Vasconcelos FBL, Coutinho I, Amorim M. Factors associated with spontaneous perineal lacerations in deliveries without episiotomy in a university maternity hospital in the city of Recife, Brazil: A cohort study. J Matern Fetal Neonatal Med 2019;32:3062-7.  Back to cited text no. 2
    
3.
Abedzadeh-Kalahroudi M, Talebian A, Sadat Z, Mesdaghinia E. Perineal trauma: Incidence and its risk factors. J Obstet Gynaecol 2019;39:206-11.  Back to cited text no. 3
    
4.
Gommesen D, Nohr EA, Drue HC, Qvist N, Rasch V. Obstetric perineal tears: risk factors, wound infection and dehiscence: A prospective cohort study. Archives of gynecology and obstetrics. Arch Gynecol Obstet 2019;300:67-77.  Back to cited text no. 4
    
5.
Leveno KJ, Spong CY, Dashe JS, Casey BM, Hoffman BL, Cunningham FG, et al. Williams Obstetrics. 25th ed: McGraw-Hill Education. New York, United States; 2018.  Back to cited text no. 5
    
6.
Jones K, Webb S, Manresa M, Hodgetts-Morton V, Morris RK. The incidence of wound infection and dehiscence following childbirth-related perineal trauma: A systematic review of the evidence. Eur J Obstet Gynecol Reprod Biol X 2019;240:1-8. doi: 10.1016/j.ejogrb. 2019.05.038.  Back to cited text no. 6
    
7.
Manresa M, Pereda A, Bataller E, Terre-Rull C, Ismail KM, Webb SS. Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: A systematic review and meta-analysis. Int Urogynecol J 2019;30:853-68.  Back to cited text no. 7
    
8.
Gartland D, MacArthur C, Woolhouse H, McDonald E, Brown SJ. Frequency, severity and risk factors for urinary and faecal incontinence at 4 years postpartum: A prospective cohort. BJOG 2016;123:1203-11.  Back to cited text no. 8
    
9.
MacArthur C, Wilson D, Herbison P, Lancashire R, Hagen S, Toozs-Hobson P, et al. Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12–year longitudinal cohort study. BJOG 2016;123:1022-9.  Back to cited text no. 9
    
10.
Tsakiridis I, Mamopoulos A, Athanasiadis A, Dagklis T. Obstetric anal sphincter injuries at vaginal delivery: A review of recently published national guidelines. Obstet Gynecol Surv 2018;73:695-702.  Back to cited text no. 10
    
11.
Reisenauer C. Presentation and management of rectovaginal fistulas after delivery. Int Urogynecol J 2016;27:859-64.  Back to cited text no. 11
    
12.
Pergialiotis V, Vlachos D, Protopapas A, Pappa K, Vlachos G. Risk factors for severe perineal lacerations during childbirth. Int J Gynaecol Obstet 2014;125:6-14.  Back to cited text no. 12
    
13.
Williams A, Gonzalez B, Fitzgerald C, Brincat C. Racial/ethnic differences in perineal lacerations in a diverse urban healthcare system. Female Pelvic Med Reconstr Surg 2019;25:15-21.  Back to cited text no. 13
    
14.
Hauck YL, Lewis L, Nathan EA, White C, Doherty DA. Risk factors for severe perineal trauma during vaginal childbirth: A Western Australian retrospective cohort study. Women Birth 2015;28:16-20.  Back to cited text no. 14
    
15.
Geller EJ, Robinson BL, Matthews CA, Celauro KP, Dunivan GC, Crane AK, et al. Perineal body length as a risk factor for ultrasound-diagnosed anal sphincter tear at first delivery. Int Urogynecol J 2014;25:631-6.  Back to cited text no. 15
    
16.
Pergialiotis V, Bellos I, Fanaki M, Vrachnis N, Doumouchtsis SK. Risk factors for severe perineal trauma during childbirth: An updated meta-analysis. Eur J Obstet Gynecol Reprod Biol X 2020;247:94-100.  Back to cited text no. 16
    
17.
D'Souza JC, Monga A, Tincello DG. Risk factors for perineal trauma in the primiparous population during non-operative vaginal delivery. Int Urogynecol J 2019;31:621-5.  Back to cited text no. 17
    
18.
Sereshti M, Deris F. Severity of striae gravidarum and its relationship with perineal trauma and vaginal lacerations during vaginal delivery of pregnant women referred to hajar hospital of Shahr-e-Kord in 2010-2011. J Adv Med Biomed Res 2013;21:107-16.  Back to cited text no. 18
    
19.
Loke AY, Davies L, Li SF. Factors influencing the decision that women make on their mode of delivery: The health belief model. BMC Health Serv Res 2015;15:274.  Back to cited text no. 19
    
20.
Chang ALS, Agredano YZ, Kimball AB. Risk factors associated with striae gravidarum. J Am Acad Dermatol 2004;51:881-5.  Back to cited text no. 20
    
21.
Atwal GSS, Manku LK, Griffiths CEM, Polson DW. Striae gravidarum in primiparae. Br J Dermatol 2006;155:965-9.  Back to cited text no. 21
    
22.
Kapadia S, Kapoor S, Parmar K, Patadia K, Vyas M. Prediction of perineal tear during childbirth by assessment of striae gravidarum score. Int J Reprod Contracept Obstet Gynecol 2014;3:208-12.  Back to cited text no. 22
    
23.
Farahnik B, Park K, Kroumpouzos G, Murase J. Striae gravidarum: Risk factors, prevention, and management. Int J Womens Dermatol 2017;3:77-85.  Back to cited text no. 23
    
24.
Kasielska-Trojan A, Sobczak M, Antoszewski B. Risk factors of striae gravidarum. Int J Cosmet Sci 2015;37:236-40.  Back to cited text no. 24
    
25.
Khajavi Shojaei K, Davati A, Kholdi N, Mohseni SM, Shalchi ST. Factors associated with striae gravidarum in primiparous women. Iran J Obstet Gynecol Infertil 2012;15:13-20.  Back to cited text no. 25
    
26.
Wahman AJ, Finan MA, Emerson SC. Striae gravidarum as a predictor of vaginal lacerations at delivery. South Med J 2000;93:873-6.  Back to cited text no. 26
    
27.
Halperin O, Noble A, Balachsan S, Klug E, Liebergall-Wischnitzer M. Association between severities of striae gravidarum and obstetric anal sphincter injuries (OASIS). Midwifery 2017;54:25-8.  Back to cited text no. 27
    
28.
Khrisnamurti S, Nurdiati DS, Setiyarini WI. Examine striae gravidarum to estimate perineal laceration. J Reprod Health 2018;5:96-104.  Back to cited text no. 28
    
29.
Osman H, Rubeiz N, Tamim H, Nassar AH. Risk factors for the development of striae gravidarum. Am J Obstet Gynecol 2007;196:62.e1-5.  Back to cited text no. 29
    
30.
Banu MA, Nargis S, Rahman MM, Sina MMI, Pervin M, Manjari M. Prediction of perineal tear during childbirth by the assessment of striae gravidarum score. Medicine Today 2019;31:64-7.  Back to cited text no. 30
    
31.
Abbas AM, Kamel FM, Salman SA. Can we predict the occurrence of perineal tears during delivery using Atwal striae gravidarum score? Am J Obstet Gynecol 2019;220:S436-S7.  Back to cited text no. 31
    
32.
Aquino CI, Guida M, Saccone G, Cruz Y, Vitagliano A, Zullo F, et al. Perineal massage during labor: A systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2020;33:1051-63.  Back to cited text no. 32
    
33.
Magoga G, Saccone G, Al-Kouatly HB, Dahlen H, Thornton C, Akbarzadeh M, et al. Warm perineal compresses during the second stage of labor for reducing perineal trauma: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019;240:93-8.  Back to cited text no. 33
    
34.
Abbas A, Kamel F, Salman SA. Prophylactic episiotomy for prevention of perineal tears in women with high striae gravidarum score. Am J Obstet Gynecol 2019;220:S436.  Back to cited text no. 34
    
35.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med 2009;151:264-9.  Back to cited text no. 35
    
36.
Patel N, Shah N, Desai G. Can perineal tear be predicted by severity of striae gravidarum score?. Int J Reprod Contracept Obstet Gynecol 2019;8:2183-7.  Back to cited text no. 36
    
37.
Yamaguchi K, Suganuma N, Ohashi K. Quality of life evaluation in Japanese pregnant women with striae gravidarum: A cross-sectional study. BMC Res Notes 2012;5:1-6. doi: 10.1186/1756-0500-5-450.  Back to cited text no. 37
    
38.
Von Elm E, Altman D, Egger M, Pocock S, Gøtzsche P, Vandenbroucke JJAIM. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Ann Intern Med 2007;147:573-7.  Back to cited text no. 38
    
39.
Wu J, Ma J, Zhang WH, Di W. Management and outcomes of pregnancy with or without lupus nephritis: A systematic review and meta-analysis. Ther Clin Risk Manag 2018;14:885-901.  Back to cited text no. 39
    
40.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88.  Back to cited text no. 40
    
41.
Bhujabal D, Rath K, Baxla P. Association of striae gravidarum score with perineal trauma among primi-para mothers. Adv Practice Nurs 2019;4:1-3.  Back to cited text no. 41
    
42.
Omidi M, Jafarnejad F, Nahidi Y, Sadeghi T. Relationship between the severity of striae gravidarum and premature rupture of membrane in primigravid women. Iran J Obstet Gynecol Infertil 2018;21:45-53.  Back to cited text no. 42
    
43.
Kurt S, Toz E, Canda MT, Sahin C, Tasyurt A. Can striae be used as a marker for the prediction of pelvic organ prolapse? Eur J Obstet Gynecol Reprod Biol X 2014;180:116-9.  Back to cited text no. 43
    
44.
Miranne JM, Kramer ME, Mete M, Iglesia CB. The association of abdominal striae with pelvic organ prolapse. Female Pelvic Med Reconstr Surg 2019;25:305-8.  Back to cited text no. 44
    
45.
Vulic M, Strinic T, Tomic S, Capkun V, Jakus IA, Ivica S. Difference in expression of collagen type I and matrix metalloproteinase-1 in uterosacral ligaments of women with and without pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol X 2011;155:225-8.  Back to cited text no. 45
    
46.
Cakir Gungor AN, Oguz S, Hacivelioglu S, Isik S, Uysal A, Gencer M, et al. Predictive value of striae gravidarum severity for intraperitoneal adhesions or uterine scar healing in patients with previous caesarean delivery. J Matern Fetal Neonatal Med 2014;27:1312-5.  Back to cited text no. 46
    
47.
Hoban LD, Pierce M, Quance J, Hayward I, McKee A, Gowda DC, et al. Use of polypentapeptides of elastin to prevent postoperative adhesions: Efficacy in a contaminated peritoneal model. J Surg Res 1994;56:179-83.  Back to cited text no. 47
    


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