title: 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.
abstract: BACKGROUND
  Severe 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.
  
  
  METHODS
  All 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.
  
  
  RESULTS
  2,784 (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.
  
  
  CONCLUSIONS
  Primiparous 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.
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Penrith South DC, NSW, Australia. h.priddis@uws.edu.au
authors.forename: Holly
authors.initials: H
authors.lastname: Priddis
authors.forename: Hannah G
authors.initials: HG
authors.lastname: Dahlen
authors.forename: Virginia
authors.initials: V
authors.lastname: Schmied
authors.forename: Annie
authors.initials: A
authors.lastname: Sneddon
authors.forename: Christine
authors.initials: C
authors.lastname: Kettle
authors.forename: Chris
authors.initials: C
authors.lastname: Brown
authors.forename: Charlene
authors.initials: C
authors.lastname: Thornton
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004841:Episiotomy; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D022125:Lacerations / Q000150:complications* / Q000601:surgery; D009517:New South Wales / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010298:Parity; D036801:Parturition; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012008:Recurrence; D012307:Risk Factors; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D014621:Vagina / Q000601:surgery; D055815:Young Adult
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