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Prior third- or fourth-degree perineal tears and recurrence risks
T N Payne1, J C Carey, W F Rayburn
1Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, USA.
Objective:
The objective of the present study is to determine the recurrence risk of a third-degree (into the anal sphincter) or a fourth-degree (into the rectum) perineal tear in women with a prior extensive laceration.
Methods:
Data were gathered from our computerized perinatal database between January 1990 and December 1994. Women who had two consecutive singleton deliveries were chosen as subjects.
Results:
The rate of an extensive perineal laceration was greater if a tear had occurred in a previous pregnancy (19 of 178 cases, 10.7% vs. 56% of 1563 cases, 3.6%, odds ratio 3.4. A 95% confidence interval: 1.8-6.4; p < 0.0001). A prior tear remained a risk factor after controlling for other variables (epidural analgesia, episiotomy, oxytocin use, operative vaginal delivery, fetal macrosomia).
Conclusion:
A prior third-degree or fourth-degree perineal tear is associated with a 3.4-fold increased risk of a recurrent severe obstetrical laceration.