Impact of third- and fourth-degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study

Authors

  • LC Edozien,

    1. Maternal and Fetal Health Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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    • LCE and IG–U share joint first authorship of this paper.
  • I Gurol-Urganci,

    Corresponding author
    1. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
    2. Office for Research and Clinical Audit, Lindsay Stewart R&D Centre, Royal College of Obstetricians and Gynaecologists (RCOG), London, UK
    • Correspondence: Dr I Gurol-Urganci, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London, WC1H 9SH, UK. Email ipek.gurol@lshtm.ac.uk

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    • LCE and IG–U share joint first authorship of this paper.
  • DA Cromwell,

    1. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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  • EJ Adams,

    1. Department of Urogynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
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  • DH Richmond,

    1. Office for Research and Clinical Audit, Lindsay Stewart R&D Centre, Royal College of Obstetricians and Gynaecologists (RCOG), London, UK
    2. Department of Urogynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
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  • TA Mahmood,

    1. Office for Research and Clinical Audit, Lindsay Stewart R&D Centre, Royal College of Obstetricians and Gynaecologists (RCOG), London, UK
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  • JH van der Meulen

    1. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Abstract

Objective

To investigate, among women who have had a third- or fourth-degree perineal tear, the mode of delivery in subsequent pregnancies as well as the recurrence rate of third- or fourth-degree tears.

Design

A retrospective cohort study of deliveries using a national administrative database.

Setting

The English National Health Service between 1 April 2004 and 31 March 2012.

Population

A total of 639 402 primiparous women who had a singleton, term, vaginal live birth between April 2004 and March 2011, and a second birth before April 2012.

Methods

Multivariable logistic regression models were used to estimate odds ratios, adjusted for other risk factors.

Main outcome measures

Mode of delivery and recurrence of tears at second birth.

Results

The rate of elective caesarean at second birth was 24.2% for women with a third- or fourth-degree tear at first birth, and 1.5% for women without (adjusted odds ratio, aOR 18.3, 95% confidence interval, 95% CI 16.4–20.4). Among women who had a vaginal delivery at second birth, the rate of third- or fourth-degree tears was 7.2% for women with a third- or fourth-degree tear at first birth, compared with 1.3% for women without (aOR 5.5, 95% CI 5.2–5.9).

Conclusions

The risk of a severe perineal tear is increased five-fold in women who had a third- or fourth-degree tear in their first delivery. This increased risk should be taken into account when decisions about mode of delivery are made.

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