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Risk of obstetric anal sphincter injury in women having a vaginal birth after a previous caesarean section: A population-based cohort study

  • Jennifer E. Jardine
    Correspondence
    Corresponding author at: Lindsey Stewart Centre, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, England, United Kingdom.
    Affiliations
    Lindsey Stewart Centre, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, England, United Kingdom

    Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom
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  • Hannah E. Knight
    Affiliations
    Lindsey Stewart Centre, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, England, United Kingdom

    Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom
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  • Fran E. Carroll
    Affiliations
    Lindsey Stewart Centre, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, England, United Kingdom
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  • Ipek Gurol-Urganci
    Affiliations
    Lindsey Stewart Centre, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, England, United Kingdom

    Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom
    Search for articles by this author
Published:February 15, 2019DOI:https://doi.org/10.1016/j.ejogrb.2019.02.004

      Abstract

      Objective

      Caesarean section is increasing in prevalence and with it the proportion of women going into their next pregnancy with a scar on their uterus. For women considering vaginal birth after caesarean (VBAC), accurate information about the associated risks is required.

      Study design

      The cohort comprised 192,057 women who had a vaginal delivery of a singleton, term, cephalic infant between the 1st April 2013 and the 31st March 2014 in England: 182,064 women who were having their first baby, and 9993 women who were having a second baby after a previous caesarean delivery. Their risk of an obstetric anal sphincter injury (OASI) was compared using a mixed-effects logistic regression model, adjusting for maternal age, use of instrument, episiotomy, prolonged labour, shoulder dystocia, and demographic factors.

      Results

      The OASI rate was 5.0% in primiparous women, 5.8% in secondiparous women undergoing VBAC after previous elective caesarean, and 7.6% in secondiparous women undergoing VBAC after previous emergency caesarean. Women having a VBAC for their second baby following an emergency caesarean section in their first delivery had a higher rate of OASI than primiparous women (adjusted OR 1.31; 95% CI: 1.20, 1.43), For women with a previous elective delivery, the rates are similar to those for primiparous women.

      Conclusion

      Women having a VBAC after emergency caesarean have a higher rate of OASI than primiparous women. This is important in the counselling of women considering VBAC.

      Keywords

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