Open Access Research article

Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000 –2008: a population based data linkage study

Holly Priddis1*, Hannah G Dahlen1, Virginia Schmied1, Annie Sneddon2, Christine Kettle3, Chris Brown4 and Charlene Thornton1

Author Affiliations

1 School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW, Australia

2 The Gold Coast Health Services District, Griffith University, 108 Nerang Street, Southport, QLD, 4215, Australia

3 Faculty of Health, Staffordshire University, Blackheath Lane, Beaconside, Stafford, ST18 0AD, UK

4 NHMRC Clinical Trials Centre, Locked Bag 77, Camperdown, NSW, 1450, Australia

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BMC Pregnancy and Childbirth 2013, 13:89  doi:10.1186/1471-2393-13-89

Published: 8 April 2013

Abstract

Background

Severe perineal trauma occurs in 0.5-10% of vaginal births and can result in significant morbidity including pain, dyspareunia and faecal incontinence. The aim of this study is to determine the risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma during their first birth in New South Wales (NSW) between 2000 – 2008.

Method

All singleton births recorded in the NSW Midwives Data Collection between 2000–2008 (n=510,006) linked to Admitted Patient Data were analysed. Determination of morbidity was based upon readmission to hospital within a 12 month time period following birth for a surgical procedure falling within four categories: 1. Vaginal repair, 2. Fistula repair, 3. Faecal and urinary incontinence repair, and 4. Rectal/anal repair. Women who experienced severe perineal trauma during their first birth were compared to women who did not.

Results

2,784 (1.6%) primiparous women experienced severe perineal trauma during this period. Primiparous women experiencing severe perineal trauma were less likely to have a subsequent birth (56% vs 53%) compared to those not who did not (OR 0.9; CI 0.81-0.99), however there was no difference in the subsequent rate of elective caesarean section (OR 1.2; 0.95-1.54), vaginal birth (including instrumental birth) (OR 1.0; CI 0.81-1.17) or normal vaginal birth (excluding instrumental birth) (OR 1.0; CI 0.85-1.17). Women were no more likely to have a severe perineal tear in the second birth if they experienced this in the first (OR 0.9; CI 0.67-1.34). Women who had a severe perineal tear in their first birth were significantly more likely to have an ‘associated surgical procedure’ within the ≤12 months following birth (vaginal repair following primary repair, rectal/anal repair following primary repair, fistula repair and urinary/faecal incontinence repair) (OR 7.6; CI 6.21-9.22). Women who gave birth in a private hospital compared to a public hospital were more likely to have an ‘associated surgical procedure’ in the 12 months following the birth (OR 1.8; CI 1.54-1.97), regardless of parity, birth type and perineal status.

Conclusion

Primiparous women who experience severe perineal trauma are less likely to have a subsequent baby, more likely to have a related surgical procedure in the 12 months following the birth and no more likely to have an operative birth or another severe perineal tear in a subsequent birth. Women giving birth in a private hospital are more likely to have an associated surgical procedure in the 12 months following birth.

Keywords:
Severe perineal trauma; Subsequent birth; Postpartum morbidities; Risk of recurrence