The impact of third- or fourth-degree perineal tears on the second pregnancy

a cohort study of 182,445 Scottish women

Research output: Contribution to journalArticle

4 Downloads (Pure)

Abstract

This study aimed to investigate the reproductive impact of a third- or fourth-degree tear in primigravid women. A retrospective population-based cohort study was conducted using data from Scottish Morbidity Records (SMR02). Primigravid women with a vaginal birth in Scotland from 1997 until 2010 were included. Exposure was third- or fourth-degree tear in the first pregnancy. The second pregnancy rate, interpregnancy interval and third- or fourth-degree tear in a second pregnancy were the primary outcomes. A nested case-control study was used to determine factors associated with repeat third- or fourth-degree tears in a second vaginal birth. Cox regression analysis and logistic regression were used to look for associations. Initial third- or fourth-degree tear occurred in 2.8% women (5174/182445). The percentage of third- or fourth-degree tears in first vaginal births increased from 1% in 1997 to 4.9% in 2010. There was no difference in having a second pregnancy (adjusted Odds Ratio (aOR) 0.98 (99%CI 0.89 – 1.09)) or the median interpregnancy interval to second pregnancy (adjusted Hazard Ratio (aHR) 1.01 (99%CI 0.95 – 1.08)) after an initial third- or fourth-degree tear. Women were over four times more likely to have a repeat injury in a subsequent vaginal birth (n=149/333, aOR 4.68 (99% 3.52 – 6.23)) and were significantly more likely to have an elective caesarean section in their second pregnancy (n= 887/3333, 26.6%; 12.75 (11.29 – 14.40)). Increased maternal age and birthweight ≥4500g were risk factors for repeat injury. Third- and fourth-degree tears are increasing in Scotland. Women do not delay or avoid childbirth after initial third- or fourth-degree tear. However, women are more likely to have a repeat third- or fourth-degree tear or an elective caesarean section in the second pregnancy. Strategies to prevent third- or fourth-degree tears are needed.
Original languageEnglish
Article number0215180
Number of pages18
JournalPloS ONE
Volume14
Issue number4
DOIs
Publication statusPublished - 11 Apr 2019

Fingerprint

cohort studies
Tears
Regression analysis
Logistics
Hazards
Cohort Studies
pregnancy
Pregnancy
Parturition
cesarean section
Scotland
Cesarean Section
odds ratio
Odds Ratio
childbirth
Birth Order
Maternal Age
Wounds and Injuries
Pregnancy Rate
case-control studies

Keywords

  • ANAL-SPHINCTER INJURIES
  • RISK-FACTORS
  • DELIVERY
  • RECURRENCE
  • EPISIOTOMY
  • INCONTINENCE
  • RUPTURE
  • TRAUMA
  • BIRTH
  • OASIS

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

@article{bfccb23df6b042e9b0f7cc0ced33931b,
title = "The impact of third- or fourth-degree perineal tears on the second pregnancy: a cohort study of 182,445 Scottish women",
abstract = "This study aimed to investigate the reproductive impact of a third- or fourth-degree tear in primigravid women. A retrospective population-based cohort study was conducted using data from Scottish Morbidity Records (SMR02). Primigravid women with a vaginal birth in Scotland from 1997 until 2010 were included. Exposure was third- or fourth-degree tear in the first pregnancy. The second pregnancy rate, interpregnancy interval and third- or fourth-degree tear in a second pregnancy were the primary outcomes. A nested case-control study was used to determine factors associated with repeat third- or fourth-degree tears in a second vaginal birth. Cox regression analysis and logistic regression were used to look for associations. Initial third- or fourth-degree tear occurred in 2.8{\%} women (5174/182445). The percentage of third- or fourth-degree tears in first vaginal births increased from 1{\%} in 1997 to 4.9{\%} in 2010. There was no difference in having a second pregnancy (adjusted Odds Ratio (aOR) 0.98 (99{\%}CI 0.89 – 1.09)) or the median interpregnancy interval to second pregnancy (adjusted Hazard Ratio (aHR) 1.01 (99{\%}CI 0.95 – 1.08)) after an initial third- or fourth-degree tear. Women were over four times more likely to have a repeat injury in a subsequent vaginal birth (n=149/333, aOR 4.68 (99{\%} 3.52 – 6.23)) and were significantly more likely to have an elective caesarean section in their second pregnancy (n= 887/3333, 26.6{\%}; 12.75 (11.29 – 14.40)). Increased maternal age and birthweight ≥4500g were risk factors for repeat injury. Third- and fourth-degree tears are increasing in Scotland. Women do not delay or avoid childbirth after initial third- or fourth-degree tear. However, women are more likely to have a repeat third- or fourth-degree tear or an elective caesarean section in the second pregnancy. Strategies to prevent third- or fourth-degree tears are needed.",
keywords = "ANAL-SPHINCTER INJURIES, RISK-FACTORS, DELIVERY, RECURRENCE, EPISIOTOMY, INCONTINENCE, RUPTURE, TRAUMA, BIRTH, OASIS",
author = "Woolner, {Andrea Mary} and Dolapo Ayansina and Mairead Black and Sohinee Bhattacharya",
note = "Data Availability: Data cannot be shared publicly because Scottish national registry data was used. Data are available from Information Services Division NHS Services Scotland (www.isdscotland.org/Products-and-services/Edris/) for researchers who meet the criteria for access to confidential data following approval by the Public Benefit and Privacy Panel for Health NHS Scotland (PBPP). The dataset was obtained from the SMR02 maternity data. Funding: This study was funded by a Wellbeing of Women (www.wellbeingofwomen.org.uk) entry level scholarship (Grant number RG12860-10) awarded to AMW. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.",
year = "2019",
month = "4",
day = "11",
doi = "10.1371/journal.pone.0215180",
language = "English",
volume = "14",
journal = "PloS ONE",
issn = "1932-6203",
publisher = "PUBLIC LIBRARY SCIENCE",
number = "4",

}

TY - JOUR

T1 - The impact of third- or fourth-degree perineal tears on the second pregnancy

T2 - a cohort study of 182,445 Scottish women

AU - Woolner, Andrea Mary

AU - Ayansina, Dolapo

AU - Black, Mairead

AU - Bhattacharya, Sohinee

N1 - Data Availability: Data cannot be shared publicly because Scottish national registry data was used. Data are available from Information Services Division NHS Services Scotland (www.isdscotland.org/Products-and-services/Edris/) for researchers who meet the criteria for access to confidential data following approval by the Public Benefit and Privacy Panel for Health NHS Scotland (PBPP). The dataset was obtained from the SMR02 maternity data. Funding: This study was funded by a Wellbeing of Women (www.wellbeingofwomen.org.uk) entry level scholarship (Grant number RG12860-10) awarded to AMW. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

PY - 2019/4/11

Y1 - 2019/4/11

N2 - This study aimed to investigate the reproductive impact of a third- or fourth-degree tear in primigravid women. A retrospective population-based cohort study was conducted using data from Scottish Morbidity Records (SMR02). Primigravid women with a vaginal birth in Scotland from 1997 until 2010 were included. Exposure was third- or fourth-degree tear in the first pregnancy. The second pregnancy rate, interpregnancy interval and third- or fourth-degree tear in a second pregnancy were the primary outcomes. A nested case-control study was used to determine factors associated with repeat third- or fourth-degree tears in a second vaginal birth. Cox regression analysis and logistic regression were used to look for associations. Initial third- or fourth-degree tear occurred in 2.8% women (5174/182445). The percentage of third- or fourth-degree tears in first vaginal births increased from 1% in 1997 to 4.9% in 2010. There was no difference in having a second pregnancy (adjusted Odds Ratio (aOR) 0.98 (99%CI 0.89 – 1.09)) or the median interpregnancy interval to second pregnancy (adjusted Hazard Ratio (aHR) 1.01 (99%CI 0.95 – 1.08)) after an initial third- or fourth-degree tear. Women were over four times more likely to have a repeat injury in a subsequent vaginal birth (n=149/333, aOR 4.68 (99% 3.52 – 6.23)) and were significantly more likely to have an elective caesarean section in their second pregnancy (n= 887/3333, 26.6%; 12.75 (11.29 – 14.40)). Increased maternal age and birthweight ≥4500g were risk factors for repeat injury. Third- and fourth-degree tears are increasing in Scotland. Women do not delay or avoid childbirth after initial third- or fourth-degree tear. However, women are more likely to have a repeat third- or fourth-degree tear or an elective caesarean section in the second pregnancy. Strategies to prevent third- or fourth-degree tears are needed.

AB - This study aimed to investigate the reproductive impact of a third- or fourth-degree tear in primigravid women. A retrospective population-based cohort study was conducted using data from Scottish Morbidity Records (SMR02). Primigravid women with a vaginal birth in Scotland from 1997 until 2010 were included. Exposure was third- or fourth-degree tear in the first pregnancy. The second pregnancy rate, interpregnancy interval and third- or fourth-degree tear in a second pregnancy were the primary outcomes. A nested case-control study was used to determine factors associated with repeat third- or fourth-degree tears in a second vaginal birth. Cox regression analysis and logistic regression were used to look for associations. Initial third- or fourth-degree tear occurred in 2.8% women (5174/182445). The percentage of third- or fourth-degree tears in first vaginal births increased from 1% in 1997 to 4.9% in 2010. There was no difference in having a second pregnancy (adjusted Odds Ratio (aOR) 0.98 (99%CI 0.89 – 1.09)) or the median interpregnancy interval to second pregnancy (adjusted Hazard Ratio (aHR) 1.01 (99%CI 0.95 – 1.08)) after an initial third- or fourth-degree tear. Women were over four times more likely to have a repeat injury in a subsequent vaginal birth (n=149/333, aOR 4.68 (99% 3.52 – 6.23)) and were significantly more likely to have an elective caesarean section in their second pregnancy (n= 887/3333, 26.6%; 12.75 (11.29 – 14.40)). Increased maternal age and birthweight ≥4500g were risk factors for repeat injury. Third- and fourth-degree tears are increasing in Scotland. Women do not delay or avoid childbirth after initial third- or fourth-degree tear. However, women are more likely to have a repeat third- or fourth-degree tear or an elective caesarean section in the second pregnancy. Strategies to prevent third- or fourth-degree tears are needed.

KW - ANAL-SPHINCTER INJURIES

KW - RISK-FACTORS

KW - DELIVERY

KW - RECURRENCE

KW - EPISIOTOMY

KW - INCONTINENCE

KW - RUPTURE

KW - TRAUMA

KW - BIRTH

KW - OASIS

UR - http://www.mendeley.com/research/impact-third-fourthdegree-perineal-tears-second-pregnancy-cohort-study-182445-scottish-women

UR - http://www.scopus.com/inward/record.url?scp=85064252500&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0215180

DO - 10.1371/journal.pone.0215180

M3 - Article

VL - 14

JO - PloS ONE

JF - PloS ONE

SN - 1932-6203

IS - 4

M1 - 0215180

ER -