Hi all: I did find a couple of articles on the risk of repeat perineal
trauma after 3rd and 4th degree tears: abstracts below...
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Risk of
repetition of a severe perineal laceration.
Peleg
D, Kennedy CM, Merrill D, Zlatnik FJ.
Department of Obstetrics and
Gynecology, University of Iowa
College of Medicine, Iowa City,
USA.
OBJECTIVE: To compare the outcome of subsequent
delivery in women with a history of a third- or fourth-degree laceration with
outcomes in women without such a history. METHODS: This retrospective study used
a perinatal database and chart review from 1978 to 1995. Only women whose first
delivery was at our institution at more than 36 weeks' gestation, vaginal
singleton, vertex presentation, and birth weight greater than 2500 g, with a
subsequent delivery were included. The women were grouped by presence or absence
of a third- or fourth-degree (severe) perineal laceration in their first
delivery. The subsequent delivery was analyzed for maternal age, weight, birth
weight, gestational age, method of delivery, use of episiotomy, and occurrence
of a severe laceration. Comparison of data was by Fisher exact and t tests.
RESULTS: Four thousand fifteen women met our starting criteria. In their first
delivery, the average birth weight, use of instrumentation, and episiotomy rate
were significantly higher in those women sustaining a severe laceration. When
compared with women without a history of severe perineal laceration, women with
such a history were at more than twice the risk for another in their subsequent
delivery. The women at highest risk (21.4%) were those sustaining a laceration
in their first delivery who underwent instrumental vaginal delivery with
episiotomy in their subsequent delivery. When episiotomy or instrumental
delivery was performed in the second vaginal birth, 52 (11.6%) of 449 women with
a history of a severe perineal laceration sustained another, compared with 98
(6.5%) of 1509 without such a history (P < .001, odds ratio 1.9, 95%
confidence interval 1.3, 2.7). CONCLUSION: Women delivering their second baby,
and in whom episiotomy or instrumentation is used, are at increased risk of
severe perineal laceration compared with women delivery
spontaneously.
Anal
incontinence in women with third or fourth degree perineal tears and subsequent
vaginal deliveries.
Sangalli MR, Floris L, Faltin D, Weil
A.
Department of Obstetrics and Gynecology, University
Hospital of
Geneva,
Switzerland.
We
contacted 208 women 13 years after they suffered an obstetrical anal sphincter
tear in order to estimate the effect of subsequent vaginal deliveries on anal
continence. Among the 177 eligible responders, 129 sustained a partial or
complete 3rd degree and 48 a 4th degree tear; 114 women had subsequent vaginal
deliveries. Anal incontinence was more common in women with 4th (25.0%) than
with 3rd degree tears (11.5%, p = 0.049). Subsequent vaginal deliveries were
associated with a higher prevalence of severe incontinence in women with 4th
degree tears (p = 0.023). No aggravation or increase in prevalence of
incontinence was observed in women with 3rd degree tears. These results suggest
that in a subsequent pregnancy, careful evaluation is necessary and an abdominal
delivery may be advisable for women with previous major sphincter
trauma.
PMID: 11065029 [PubMed - indexed for MEDLINE]
