title: Third and fourth degree perineal tears--the risk of recurrence in subsequent pregnancy.
abstract: OBJECTIVE
  To assess the risk of recurrence of third- and fourth-degree perineal tears (34DPT) and to determine whether previous 34DPT is an independent risk factor for 34DPT in subsequent deliveries.
  
  
  METHODS
  The study group included all women who had a vaginal delivery complicated by 34DPT (2000-2012, N = 356) and subsequently delivered again in the same medical center (N = 204). The rate of recurrence of 34DPT was compared with a control group of women who had a previous vaginal delivery not complicated by 34DPT (N = 58 581) and had a subsequent delivery in the same time period (N = 23 045).
  
  
  RESULTS
  Women in the past-34DPT group had a higher rate of CS (18.6% versus 10.1%, p < 0.001), fetal head in occiput-posterior position (POP; 2.5% versus 0.7%, p = 0.004) and mediolateral episiotomy (25.5% versus 19.4%, p = 0.03). Women in the past-34DPT group had a higher rate of 34DPT in the subsequent delivery (2.0% versus 0.3%, p < 0.001). The rate of recurrence of 34DPT was considerably higher among women with past fourth-degree tear versus women with past third-degree tear (22.2% versus 1.0%, p < 0.001). 34DPT in previous pregnancy is independently associated with increased risk of 34DPT in subsequent delivery (OR = 4.6, 95%-CI 1.3-15.3).
  
  
  CONCLUSIONS
  Women who experienced 34DPT in their previous pregnancy have an increased risk for recurrence of 34DPT in subsequent pregnancy, especially in cases of past fourth-degree tears.
authors.affiliation: Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva and.
authors.forename: Yariv
authors.initials: Y
authors.lastname: Yogev
authors.forename: Liran
authors.initials: L
authors.lastname: Hiersch
authors.forename: Lance
authors.initials: L
authors.lastname: Maresky
authors.forename: Nir
authors.initials: N
authors.lastname: Wasserberg
authors.forename: Arnon
authors.initials: A
authors.lastname: Wiznitzer
authors.forename: Nir
authors.initials: N
authors.lastname: Melamed
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004841:Episiotomy; D005260:Female; D006801:Humans; D007746:Labor Presentation; D022125:Lacerations / Q000145:classification / Q000209:etiology; D010298:Parity; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors