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A prior cesarean section and incidence of obstetric anal sphincter injury

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Abstract

Introduction and hypothesis

Obstetric anal sphincter injury (OASIS) following birth may have serious, long-term effects on affected women, including fecal incontinence, despite primary repair.

Methods

This was a retrospective population-based register study. Women with OASIS grouped by order of vaginal delivery and prior cesarean section (CS) were compared separately with women without OASIS using logistic regression analysis. The aim was to assess an association between prior CS and incidence of OASIS across groups of women categorized according to singleton first, second, and third vaginal deliveries between 1997 and 2007 in Finland.

Results

The incidence of OASIS was 1.8 % at a first vaginal delivery after a prior CS compared with 1.0 % at a first vaginal delivery without prior CS. After adjustment prior CS was associated with a 1.42-fold risk of OASIS only at the first vaginal delivery, with no further significant risk after one or two previous vaginal deliveries. One centimeter increase in maternal height was associated with a 2 % decrease in OASIS incidence at the first vaginal delivery.

Conclusions

Prior CS is a significant risk factor for OASIS at the first vaginal delivery. This suggests that relative fetopelvic disproportion leading to CS for a first delivery also predisposes to OASIS at a first vaginal delivery since 40 % of the increased incidence of OASIS risk was explained by birthweight and 4 % by maternal height.

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Conflicts of interest

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Authors and Affiliations

  1. Savonia University of Applied Sciences, P.O. Box 72, 74101, Iisalmi, Finland

    Sari Räisänen

  2. Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland

    Katri Vehviläinen-Julkunen

  3. Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland

    Katri Vehviläinen-Julkunen

  4. Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK

    Rufus Cartwright

  5. National Institute for Health and Welfare (THL), P.O. Box 30, Lintulahdenkuja 4, 00271, Helsinki, Finland

    Mika Gissler

  6. Nordic School of Public Health, Gothenburg, Sweden

    Mika Gissler

  7. Department of Obstetrics and Gynaecology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland

    Seppo Heinonen

  8. University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland

    Seppo Heinonen

Authors
  1. Sari Räisänen
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  2. Katri Vehviläinen-Julkunen
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  3. Rufus Cartwright
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  4. Mika Gissler
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  5. Seppo Heinonen
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Corresponding author

Correspondence to Sari Räisänen.

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Räisänen, S., Vehviläinen-Julkunen, K., Cartwright, R. et al. A prior cesarean section and incidence of obstetric anal sphincter injury. Int Urogynecol J 24, 1331–1339 (2013). https://doi.org/10.1007/s00192-012-2006-6

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  • DOI: https://doi.org/10.1007/s00192-012-2006-6

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