Re: [ozmidwifery] 3rd degree tear and C/S

[Marilyn Kleidon]

This question has come up a lot recently (on this list) so I am wondering if this is now pretty common practice. In discussions with other midwives I have found quite a diversity of opinion on future risk of increased perineal trauma and subsequent vaginal births. I personally have only seen and experienced good outcomes however that is not everyones experience so I just did a literature search on PUBMED entering "third degree perineal trauma" AND "cesarean section" and 3 articles came up I will paste the abstract of the first one below. I then went to the related articles button of this article and found many articles on perineal trauma: research on risk factors, prevention and incontinence. However, I did not find one article recommending c/s for subsequent births. So, I guess the advice of the registrar for a future c/s is not evidence based. Anyway here is the article I found: (incidently, prior 3rd or 4th degree tear was not listed as a risk factor), not that pubmed is the only place to search does anyone have any research that supports this advice?   marilyn     Acta Obstet Gynecol Scand. 2001 Mar;80(3):229-34. Related Articles, Links Third and fourth degree perineal tears. Predictor factors in a referral hospital. Jander C, Lyrenas S. Department of Women's and Children's Health, Section for Obstetrics and Gynecology, Akademiska Sjukhuset, Uppsala, Sweden. BACKGROUND: Tears of the anal sphincter are a feared complication of vaginal delivery, as many as 50% of these patients experience incontinence as an after-effect. Identifying significant predictor factors leading to third or fourth degree perineal tears during vaginal delivery was the objective of this study. METHODS: During a two-year period (1995-1996), a third or fourth degree perineal rupture occurred in 214 women (3.7%) after vaginal delivery. Data from these deliveries were collected and compared to data from deliveries without anal sphincter tears in order to identify risk factors. A stepwise logistic regression model was used for the analysis. RESULTS: Independent risk factors of significance were vaginal nulliparity, a squatting position on a delivery chair, maternal age exceeding 35 years, baby's birth weight over 4000 g, vacuum extraction (both outlet and mid release), median episiotomy, oxytocin augmentation and birthing between 3 a.m. and 6 a.m. CONCLUSIONS: This study identified several factors associated with anal sphincter tears. Median episiotomy should be avoided. Delivery, while squatting on a low chair, should be used with caution. A woman with one or more risk factors requires caution by birth attendants during delivery. Gynecologists should consider the option of cesarean section instead of vacuum extraction, especially when mid release is needed in the presence of macrosomia. A continuous audit regarding instrumental delivery technique is necessary. PMID: 11207488 [PubMed - indexed for MEDLINE] ----- Original Message ----- From: Veronica To: [EMAIL PROTECTED] Sent: Tuesday, June 24, 2003 11:26 PM Subject: [ozmidwifery] 3rd degree tear and C/S Hi all, I wanted to know weather it is common place for women who have had a 3rd degree tear to be offered an elective C/S for thier next birth.  Today I was working with a midwifery student and we did a beautiful birth with a women who was having her first babe. Unfortunately she had a 2nd degree tear that needed attending to.  The resident that was on came and sutured her but then we had to call the registrar because she was unsure of what she was doing.  The registrar had to take the sutures out and in doing this the tear extended to a 3rd degree tear.  Afterwards, I was reading the notes and talking to the midwife who had taken over the care of the women and the registrar had offered the women a rpt C/S or an elective episiotomy for her next birth.  I wanted to know if there was any research to back up this because I was pretty upset at the thought of this women having to have a C/S after birthing so fantasically.  Veronica