There is an increased risk of severe perineal tearing during childbirth in women who had such a tear in a previous delivery, suggests a new study published today (9 July) in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG).
This study, investigates among women who have had a third or fourth degree perineal tear, the mode of delivery in subsequent pregnancies and the recurrence of severe perineal tears.
Most women tear to some extent during childbirth and in some women the tear may be more extensive. A third degree tear extends downwards from the vaginal wall and perineum to the anal sphincter, the muscle that controls the anus and a fourth degree tear extends to the anal canal as well as the rectum. In England, the rate of reported severe perineal tears has tripled from 1.8% to 5.9% between 2000 and 2012.
The study used a cohort of 639,402 first-time mothers who had a vaginal delivery of a single baby between April 2004 and March 2011 and a second birth before April 2012. Data came from the Hospital Episode Statistics (HES) which includes all maternity admissions in NHS hospitals.
Results show that the prevalence of third or fourth degree tearing at first birth for the cohort was 3.8%. Among women who had a third or fourth degree tear at first birth, 24.2% were delivered by elective caesarean section, compared with 1.5% of women who did not tear at first birth.
Furthermore, the report found that among women who had a vaginal delivery at second birth, the rate of a severe tear was 7.2% in women with a tear at first birth, compared to 1.3% in women without, a more than five-fold increase in risk.
Other risk factors to increase the risk of third and fourth degree tearing at second birth include; high birth weight, forceps delivery and the presence of shoulder dystocia. Additionally tearing was higher in older women, women living in the least deprived communities and in Asian women
|Contact: Nicole Weingartner|