Is severe perineal damage increased in women with prior anal sphincter injury?

Edwards, Heather E.; Grotegut, Chad A.; Harmanli, Oz; Rapkin, David; Dandolu, Vani

doi:10.1080/14767050600921307

Cited by 30 publications

(50 citation statements)

References 18 publications

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“…Studies by Edwards et al (2006) and Scheer et al (2009) support the findings in this study, while Lowder (2007) reported that women who had experienced severe perineal trauma with their index pregnancy, were at increased risk of subsequent perineal trauma in comparison to women with no history of perineal trauma (7.2% versus 2.3%). This risk of recurrence was increased as a result of episiotomy, malpresentation, shoulder dystocia, and birth weight greater than 3500 grams [19,20,26]. These associations have also been reported elsewhere [18,20,32].…”

Section: Discussionmentioning

confidence: 55%

“…This risk of recurrence was increased as a result of episiotomy, malpresentation, shoulder dystocia, and birth weight greater than 3500 grams [19,20,26]. These associations have also been reported elsewhere [18,20,32]. …”

Section: Discussionmentioning

confidence: 55%

“…For women who are symptomatic for urinary, flatus or faecal incontinence, or have findings that deviate from normal via manometric or endoanal ultrasonography associated with severe perineal trauma, it is suggested that an elective caesarean section should be recommended by the health care professional [3]. However, debate continues as to the most appropriate management of the subsequent mode of birth following severe perineal trauma, with discussions focussed around the protective mechanisms, potential morbidities and increased risk of subsequent perineal trauma associated with operative vaginal and vaginal births [3,18,20,21,26]. …”

Section: Discussionmentioning

confidence: 99%

“…Studies investigating the risk of recurrence of in subsequent births for women who have experienced severe perineal trauma vary widely in findings [18-20]. Studies by Edwards et al (2006) and Scheer et al (2009) support the findings in this study, while Lowder (2007) reported that women who had experienced severe perineal trauma with their index pregnancy, were at increased risk of subsequent perineal trauma in comparison to women with no history of perineal trauma (7.2% versus 2.3%).…”

Section: Discussionmentioning

confidence: 99%

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Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000 –2008: a population based data linkage study

Priddis

Dahlen

Schmied

et al. 2013

BMC Pregnancy Childbirth

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BackgroundSevere perineal trauma occurs in 0.5-10% of vaginal births and can result in significant morbidity including pain, dyspareunia and faecal incontinence. The aim of this study is to determine the risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma during their first birth in New South Wales (NSW) between 2000 – 2008.MethodAll singleton births recorded in the NSW Midwives Data Collection between 2000–2008 (n=510,006) linked to Admitted Patient Data were analysed. Determination of morbidity was based upon readmission to hospital within a 12 month time period following birth for a surgical procedure falling within four categories: 1. Vaginal repair, 2. Fistula repair, 3. Faecal and urinary incontinence repair, and 4. Rectal/anal repair. Women who experienced severe perineal trauma during their first birth were compared to women who did not.Results2,784 (1.6%) primiparous women experienced severe perineal trauma during this period. Primiparous women experiencing severe perineal trauma were less likely to have a subsequent birth (56% vs 53%) compared to those not who did not (OR 0.9; CI 0.81-0.99), however there was no difference in the subsequent rate of elective caesarean section (OR 1.2; 0.95-1.54), vaginal birth (including instrumental birth) (OR 1.0; CI 0.81-1.17) or normal vaginal birth (excluding instrumental birth) (OR 1.0; CI 0.85-1.17). Women were no more likely to have a severe perineal tear in the second birth if they experienced this in the first (OR 0.9; CI 0.67-1.34). Women who had a severe perineal tear in their first birth were significantly more likely to have an ‘associated surgical procedure’ within the ≤12 months following birth (vaginal repair following primary repair, rectal/anal repair following primary repair, fistula repair and urinary/faecal incontinence repair) (OR 7.6; CI 6.21-9.22). Women who gave birth in a private hospital compared to a public hospital were more likely to have an ‘associated surgical procedure’ in the 12 months following the birth (OR 1.8; CI 1.54-1.97), regardless of parity, birth type and perineal status.ConclusionPrimiparous women who experience severe perineal trauma are less likely to have a subsequent baby, more likely to have a related surgical procedure in the 12 months following the birth and no more likely to have an operative birth or another severe perineal tear in a subsequent birth. Women giving birth in a private hospital are more likely to have an associated surgical procedure in the 12 months following birth.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000 –2008: a population based data linkage study

Priddis

Dahlen

Schmied

et al. 2013

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…A recent population‐based study in Australia found no such increase, however . Results from hospital‐based studies range from no increase to up to eight‐fold higher risks . Apart from the size and setting of the studies, there are other factors that make comparisons between studies and applicability to maternity care in England difficult.…”

Section: Introductionmentioning

confidence: 99%

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

Edozien

Gurol‐Urganci

Cromwell

et al. 2014

BJOG

117

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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. 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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Hyaluronidase for reducing perineal trauma

Zhang¹,

Wang²,

Li³

et al. 2013

Cochrane Database of Systematic Reviews

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Is severe perineal damage increased in women with prior anal sphincter injury?

Abstract: Prior anal sphincter laceration does not result in an increased rate of recurrence. Operative vaginal delivery particularly with episiotomy is a risk factor for both initial and recurrent laceration.

Cited by 30 publications

References 18 publications

Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000 –2008: a population based data linkage study

Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000 –2008: a population based data linkage study

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

Hyaluronidase for reducing perineal trauma

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