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Severe perineal trauma among women undergoing vaginal birth after cesarean delivery : A population-based cohort study

Elvander, Charlotte ; Ahlberg, Mia ; Edqvist, Malin LU and Stephansson, Olof (2019) In Birth 46(2). p.379-386
Abstract

Background: To examine risk of severe perineal trauma among nulliparous women and those undergoing vaginal birth after cesarean delivery (VBAC). Methods: This is a population-based cohort study of all births to women with their two first consecutive singleton pregnancies in Stockholm-Gotland Sweden between 2008 and 2014. Risk of severe perineal trauma was compared between nulliparous women and those undergoing VBAC with severe perineal trauma being the main outcome measure. Associations between indication and timing of primary cesarean delivery and risk of severe perineal trauma in subsequent vaginal birth were analyzed using Poisson regression analysis. Results: The rate of severe perineal trauma among nulliparous women and those... (More)

Background: To examine risk of severe perineal trauma among nulliparous women and those undergoing vaginal birth after cesarean delivery (VBAC). Methods: This is a population-based cohort study of all births to women with their two first consecutive singleton pregnancies in Stockholm-Gotland Sweden between 2008 and 2014. Risk of severe perineal trauma was compared between nulliparous women and those undergoing VBAC with severe perineal trauma being the main outcome measure. Associations between indication and timing of primary cesarean delivery and risk of severe perineal trauma in subsequent vaginal birth were analyzed using Poisson regression analysis. Results: The rate of severe perineal trauma among nulliparous women and those undergoing VBAC was 7.0% and 12.3%, respectively. Compared with nulliparous women, those undergoing VBAC were significantly older, had a shorter stature, and gave birth in a non-upright position to heavier infants with larger head circumferences. The rate of instrumental vaginal delivery among nulliparous women and those undergoing VBAC was 19.3% and 20.2%, respectively (P = 0.331). An increased risk of severe perineal trauma remained after adjustments among those undergoing VBAC (adjusted risk ratio 1.42, 95% CI 1.23-1.63). Level of risk was not associated with indication (dystocia or signs of fetal distress) of primary cesarean delivery, nor how far the woman had progressed in labor (fully dilated versus planned cesarean delivery) before delivering by cesarean. Conclusions: Compared with nulliparous women, those undergoing VBAC are at increased risk of severe perineal trauma, irrespective of indication and timing of primary cesarean delivery.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cesarean delivery, severe perineal trauma, vaginal birth after cesarean delivery (VBAC)
in
Birth
volume
46
issue
2
pages
379 - 386
publisher
Medical Consumer Communications
external identifiers
  • scopus:85055289663
  • pmid:30350424
ISSN
0730-7659
DOI
10.1111/birt.12402
language
English
LU publication?
yes
id
605105d1-0b7a-48f2-8194-55711bb10360
date added to LUP
2018-12-10 14:17:01
date last changed
2020-01-13 01:16:24
@article{605105d1-0b7a-48f2-8194-55711bb10360,
  abstract     = {<p>Background: To examine risk of severe perineal trauma among nulliparous women and those undergoing vaginal birth after cesarean delivery (VBAC). Methods: This is a population-based cohort study of all births to women with their two first consecutive singleton pregnancies in Stockholm-Gotland Sweden between 2008 and 2014. Risk of severe perineal trauma was compared between nulliparous women and those undergoing VBAC with severe perineal trauma being the main outcome measure. Associations between indication and timing of primary cesarean delivery and risk of severe perineal trauma in subsequent vaginal birth were analyzed using Poisson regression analysis. Results: The rate of severe perineal trauma among nulliparous women and those undergoing VBAC was 7.0% and 12.3%, respectively. Compared with nulliparous women, those undergoing VBAC were significantly older, had a shorter stature, and gave birth in a non-upright position to heavier infants with larger head circumferences. The rate of instrumental vaginal delivery among nulliparous women and those undergoing VBAC was 19.3% and 20.2%, respectively (P = 0.331). An increased risk of severe perineal trauma remained after adjustments among those undergoing VBAC (adjusted risk ratio 1.42, 95% CI 1.23-1.63). Level of risk was not associated with indication (dystocia or signs of fetal distress) of primary cesarean delivery, nor how far the woman had progressed in labor (fully dilated versus planned cesarean delivery) before delivering by cesarean. Conclusions: Compared with nulliparous women, those undergoing VBAC are at increased risk of severe perineal trauma, irrespective of indication and timing of primary cesarean delivery.</p>},
  author       = {Elvander, Charlotte and Ahlberg, Mia and Edqvist, Malin and Stephansson, Olof},
  issn         = {0730-7659},
  language     = {eng},
  number       = {2},
  pages        = {379--386},
  publisher    = {Medical Consumer Communications},
  series       = {Birth},
  title        = {Severe perineal trauma among women undergoing vaginal birth after cesarean delivery : A population-based cohort study},
  url          = {http://dx.doi.org/10.1111/birt.12402},
  doi          = {10.1111/birt.12402},
  volume       = {46},
  year         = {2019},
}