Severe Perineal Lacerations in First Delivery: Association with Subsequent Fertility Outcomes
Abstract
BACKGROUND: Worldwide, approximately 3-5% of women who deliver vaginally sustain a severe perineal laceration (SPL), which involves disruption of the anal sphincter and rectal mucosa. While the physiological effects of severe perineal lacerations are well documented, we lack a detailed understanding of the wide-ranging impacts, including psychological effects and the implications for future birth planning. Prior studies suggest that a traumatic delivery may influence a woman’s future reproductive desires and intentions, but the impacts have not been studied at the population level. In this study, we describe the effect of experiencing severe perineal lacerations during a first delivery on birth spacing and other fertility outcomes in a large, population-based cohort.
METHODS: We used data from the Swedish Medical Birth Register, linked with additional national registers. Women with a live, vaginal, singleton, term first delivery during 1992 – 2013 (n = 724,994) were included in the study and followed until December 31, 2014. Reproductive outcomes of interest include total pregnancies, interpregnancy interval, and elective cesarean at second delivery. Severe perineal lacerations were defined using diagnostic codes.
RESULTS: In this population, 5.8% (n = 42,112) of women experienced SPL during their first birth. The average interpregnancy interval between first birth and second conception was 2.29 (SD 1.66) years among women who experienced SPL during their first delivery, compared to 2.37 (SD 1.90) years among women who did not (p < 0.001). Compared with women who did not experience SPL, women who experienced SPL had a lower risk of delivering a second birth during the study period (HR 0.98; 95%CI 0.96, 0.99) (Table 2). This risk was attenuated in the adjusted models. Among the second births, 20,853 (2.88%) women delivered by a scheduled cesarean. Compared with women who did not experience SPL degree tearing, women who experienced SPL during their first delivery had 5.58 (95% CI: 5.43, 5.75) times the risk of delivering their second child via scheduled cesarean.
CONCLUSION: In this dynamic time of maternity care redesign and renewed emphasis on birth spacing, it is important to consider the wide-ranging consequences of experiencing severe perineal tears. This focus may highlight unmet needs and areas for increased clinical and policy intervention.
Severe Perineal Lacerations in First Delivery: Association with Subsequent Fertility Outcomes
BACKGROUND: Worldwide, approximately 3-5% of women who deliver vaginally sustain a severe perineal laceration (SPL), which involves disruption of the anal sphincter and rectal mucosa. While the physiological effects of severe perineal lacerations are well documented, we lack a detailed understanding of the wide-ranging impacts, including psychological effects and the implications for future birth planning. Prior studies suggest that a traumatic delivery may influence a woman’s future reproductive desires and intentions, but the impacts have not been studied at the population level. In this study, we describe the effect of experiencing severe perineal lacerations during a first delivery on birth spacing and other fertility outcomes in a large, population-based cohort.
METHODS: We used data from the Swedish Medical Birth Register, linked with additional national registers. Women with a live, vaginal, singleton, term first delivery during 1992 – 2013 (n = 724,994) were included in the study and followed until December 31, 2014. Reproductive outcomes of interest include total pregnancies, interpregnancy interval, and elective cesarean at second delivery. Severe perineal lacerations were defined using diagnostic codes.
RESULTS: In this population, 5.8% (n = 42,112) of women experienced SPL during their first birth. The average interpregnancy interval between first birth and second conception was 2.29 (SD 1.66) years among women who experienced SPL during their first delivery, compared to 2.37 (SD 1.90) years among women who did not (p < 0.001). Compared with women who did not experience SPL, women who experienced SPL had a lower risk of delivering a second birth during the study period (HR 0.98; 95%CI 0.96, 0.99) (Table 2). This risk was attenuated in the adjusted models. Among the second births, 20,853 (2.88%) women delivered by a scheduled cesarean. Compared with women who did not experience SPL degree tearing, women who experienced SPL during their first delivery had 5.58 (95% CI: 5.43, 5.75) times the risk of delivering their second child via scheduled cesarean.
CONCLUSION: In this dynamic time of maternity care redesign and renewed emphasis on birth spacing, it is important to consider the wide-ranging consequences of experiencing severe perineal tears. This focus may highlight unmet needs and areas for increased clinical and policy intervention.