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Sir,

Our paper describes the determination of risk factors for the occurrence of anal sphincter injury at vaginal delivery with the help of the Dutch National Obstetric Database1. In this database, the use of forceps, vacuum extraction, other types of assisted vaginal delivery and the indication for use (fetal distress, secondary arrest) are registered.

The database contains no information on whether the use of forceps concerned a rotational forceps or not. This makes it impossible to make a comparison of rotational forceps vs vacuum deliveries. However, to our knowledge, rotational forceps was rarely, if ever, performed in the Netherlands during the study period.

All deliveries in the Netherlands beyond 16 weeks of gestation can be entered in the Dutch National Obstetric Database. We have analysed the data without gestational age as a separate risk factor, because we feel that, with regard to the risk of third degree perineal tears, gestational age is closely linked to birthweight. In our opinion, the risk of anal sphincter damage depends on birthweight and not the gestational age at delivery. This opinion is supported by the results of previous studies2,3.

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