Influence of previous delivery mode on perineal trauma risk
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Authors
Thorne, E.P.C
Durnea, C.M
Sedgwick, P.M
Doumouchtsis, S.K
Issue Date
2022
Type
Scientific Paper
Language
Keywords
Research Subject Categories::MEDICINE::Surgery::Obstetrics and women's diseases::Obstetrics and gynaecology , Research Subject Categories::MEDICINE::Surgery::Obstetrics and women's diseases::Reproductive and perinatal care
Alternative Title
Abstract
Objective: To evaluate the impact of a previous pregnancy and delivery on perineal trauma rates in the subsequent vaginal birth.
Methods: Retrospective cohort study. The perineal outcomes of secundiparous women with history of previous (first) delivery in one of three categories: failed operative vaginal delivery (FOVD) and second-stage emergency cesarean section (EmCS); elective cesarean section (ElCS), and vaginal delivery (VD) with intact perineum, were compared with a control primiparous group.
Results: The percentage obstetric anal sphincter injuries (OASIS)at first vaginal delivery was 17.3% (n = 9) after previous FOVD+EmCS, 12.9% (n = 18) after previous ElCS, and 0.6% (n = 9) after previous VD maintaining an intact perineum, compared with 6% (n = 1193) in the control primiparous group of women. Multivariate regression analysis demonstrated that previous FOVD+EmCS and ElCS were associated with a statistically significant increased risk of OASIS of 180% and 110% when compared with control (odds ratio [OR] 2.80; 95% confidence interval [CI] 1.35-5.78 and OR 2.10; 95% CI 1.27-3.48, respectively). Previous VD with intact perineum was associated with a statistically significantly reduced risk of OASIS (OR 0.09; 95% CI 0.04-0.17).
Conclusions: Previous FOVD+EmCS and ElCS were associated with increased risk of OASIS in subsequent vaginal delivery compared with control, whereas previous VD with intact perineum was associated with decreased risk.
Keywords: cesarean section; obstetric anal sphincter injuries; perineal tear; previous mode of delivery; risk factors; vaginal birth after cesarean.
© 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
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Citation
Thorne EPC, Durnea CM, Sedgwick PM, Doumouchtsis SK. Influence of previous delivery mode on perineal trauma risk. Int J Gynaecol Obstet. 2022 Dec;159(3):757-763. doi: 10.1002/ijgo.14218. Epub 2022 May 22. PMID: 35426118; PMCID: PMC9790575.