title: Risk of episiotomy and perineal lacerations recurring after first delivery.
abstract: BACKGROUND
  To assess whether the presence of an episiotomy or spontaneous perineal trauma at the first delivery increases the risk of perineal trauma at the following one.
  
  
  METHODS
  We studied 2,695 women who gave birth twice at Virgen de las Nieves University Hospital of Granada, Spain. All second deliveries were from 2004 to 2011 and prenatal database records were used to obtain information about the first deliveries. All births, first and second, were single, vaginal, unassisted, and in a cephalic presentation. Two groups were made as follows: Intact perineum (no perineal trauma or first-degree spontaneous tear at the first delivery) and perineal trauma (episiotomy or second-degree or higher spontaneous tear at the first delivery). Both groups were compared according to the degree of perineal trauma at the second delivery.
  
  
  RESULTS
  Women included in the perineal trauma group were significantly older and a higher proportion was attended by a midwife with an obstetrician present in the delivery room. No differences were observed according to gestational age, epidural analgesia or fetal birth weight. Adjusting for these possible compounding factors and the year of birth, the risk of undergoing a second-degree or higher spontaneous tear at their next delivery was fivefold (adjusted OR 5.15, 95% CI 3.11-8.54), and the risk of undergoing an episiotomy in the second delivery was threefold (adjusted OR 3.20, 95% CI 2.19-4.69) for the perineal trauma group.
  
  
  CONCLUSIONS
  The risk of undergoing a spontaneous perineal tear or an episiotomy in the second delivery is increased by the practice of episiotomy in the first one.
authors.affiliation: Department of Obstetrics and Gynecology, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Manzanares
authors.forename: Davinia
authors.initials: D
authors.lastname: Cobo
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Moreno-Martínez
authors.forename: Mar
authors.initials: M
authors.lastname: Sánchez-Gila
authors.forename: Alicia
authors.initials: A
authors.lastname: Pineda
mesh_terms: D000328:Adult; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology*; D010298:Parity; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain
keywords: Episiotomy; delivery; perineal tear