The authors of the study recognise the risks associated with an elective caesarean, and decisions about subsequent mode of delivery in women who had a severe perineal tear in an earlier pregnancy must be weighed against the clinical and psychological impacts of severe perineal tearing.
Dr Leroy Edozien, a consultant obstetrician from the University of Manchester and co-author of the study said:
"Our study shows that the relative risk of a repeat tear is a five-fold increase and the absolute risk of a repeat tear is about 7 in 100. Clinicians should communicate both the relative and the absolute risk when discussing mode of delivery with women who suffered a severe tear in their previous pregnancy."
Dr Ipek Gurol-Urganci from the London School of Hygiene and Tropical Medicine and co-author added:
"Our results emphasise the need for clear national guidance for healthcare professionals on the optimal mode of delivery for women with a prior severe perineal tear so that they can be counselled appropriately."
John Thorp, BJOG deputy editor-in-chief said:
"This study captures over 96% of all deliveries in NHS hospitals in England over a 7 year period, and represents the first piece of research into the mode of delivery and recurrence rate in a pregnancy subsequent to a third or fourth degree perineal tear.
"The results highlight the increased risk of severe tearing in women who have a third or fourth degree tear in their first delivery and therefore will help women along with a multidisciplinary team of healthcare professionals to make decisions about the mode of delivery in future pregnancies to ensure the best outcomes for mother and baby."
|Contact: Nicole Weingartner|