title: Impact of third- and fourth-degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study.
abstract: OBJECTIVE
  To investigate, among women who have had a third- or fourth-degree perineal tear, the mode of delivery in subsequent pregnancies as well as the recurrence rate of third- or fourth-degree tears.
  
  
  METHODS
  A retrospective cohort study of deliveries using a national administrative database.
  
  
  METHODS
  The English National Health Service between 1 April 2004 and 31 March 2012.
  
  
  METHODS
  A total of 639,402 primiparous women who had a singleton, term, vaginal live birth between April 2004 and March 2011, and a second birth before April 2012.
  
  
  METHODS
  Multivariable logistic regression models were used to estimate odds ratios, adjusted for other risk factors.
  
  
  METHODS
  Mode of delivery and recurrence of tears at second birth.
  
  
  RESULTS
  The rate of elective caesarean at second birth was 24.2% for women with a third- or fourth-degree tear at first birth, and 1.5% for women without (adjusted odds ratio, aOR 18.3, 95% confidence interval, 95% CI 16.4-20.4). Among women who had a vaginal delivery at second birth, the rate of third- or fourth-degree tears was 7.2% for women with a third- or fourth-degree tear at first birth, compared with 1.3% for women without (aOR 5.5, 95% CI 5.2-5.9).
  
  
  CONCLUSIONS
  The risk of a severe perineal tear is increased five-fold in women who had a third- or fourth-degree tear in their first delivery. This increased risk should be taken into account when decisions about mode of delivery are made.
authors.affiliation: Maternal and Fetal Health Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
authors.forename: L C
authors.initials: LC
authors.lastname: Edozien
authors.forename: I
authors.initials: I
authors.lastname: Gurol-Urganci
authors.forename: D A
authors.initials: DA
authors.lastname: Cromwell
authors.forename: E J
authors.initials: EJ
authors.lastname: Adams
authors.forename: D H
authors.initials: DH
authors.lastname: Richmond
authors.forename: T A
authors.initials: TA
authors.lastname: Mahmood
authors.forename: J H
authors.initials: JH
authors.lastname: van der Meulen
mesh_terms: D000328:Adult; D000367:Age Factors; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D004739:England; D004841:Episiotomy / Q000706:statistics & numerical data; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D022125:Lacerations / Q000453:epidemiology*; D016015:Logistic Models; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Administrative data; caesarean section; severe perineal trauma