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Obstetric Anal Sphincter Injury: Vaginal Birth After Cesarean Versus First Vaginal Delivery
Brigid S Mumford1, Lara Lemon2, John Harris3
1University of Pittsburgh School of Medicine, UPMC Magee-Womens Hospital, Pittsburgh, PA.
Urogynecology (Philadelphia, Pa.)
|January 21, 2025
Summary
Vaginal birth after cesarean (VBAC) had a higher proportion of obstetric anal sphincter injuries (OASIs). However, VBAC was not an independent risk factor for OASIs in this study.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Surgical Outcomes
Background:
- Limited contemporary data exist on the association between vaginal birth after cesarean (VBAC) and obstetric anal sphincter injuries (OASIs).
- Previous studies have yielded mixed results regarding this relationship.
Purpose of the Study:
- To investigate whether VBAC is associated with an increased risk of OASIs.
- To clarify the contemporary relationship between VBAC and OASI rates.
Main Methods:
- Retrospective cohort study of liveborn deliveries from 2018-2022 in a large academic health system.
- Compared OASI proportions between first-time vaginal deliveries and first-time VBACs.
- Utilized multivariable logistic regression to identify independent risk factors.
Main Results:
- A higher proportion of OASIs was observed in the VBAC group (6.9%) compared to the primiparous vaginal delivery group (5.1%) (P=0.02).
- VBAC was not significantly associated with OASIs in multivariable analysis (OR=1.01, P=0.95).
- Operative vaginal delivery, older maternal age, and Asian race were independently associated with increased OASI risk, while Black race was associated with lower risk.
Conclusions:
- Despite a higher observed proportion of OASIs in the VBAC group, VBAC itself was not identified as an independent risk factor for OASI.
- Factors such as operative vaginal delivery and maternal demographics play a significant role in OASI risk.
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