{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T05:31:33Z","timestamp":1783056693063,"version":"3.54.6"},"reference-count":18,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2014,3,13]],"date-time":"2014-03-13T00:00:00Z","timestamp":1394668800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the incidence of obstetric anal sphincter injury in women who had a successful vaginal birth after a previous caesarean delivery (VBAC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective analysis of prospectively gathered data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>A tertiary referral university institution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>All secundiparous women with a previous caesarean delivery who had a VBAC from 2001 to 2011.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Details of maternal demographics, intrapartum characteristics and outcomes were examined in cases of VBAC with accompanying anal sphincter injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Rates of obstetric anal sphincter injury and associated risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period there were 3071 trials of labour in secundiparous women with a previous caesarean delivery; 65% (1981\/3071) of these had a successful VBAC. Women having a VBAC were at greater risk of anal sphincter injury than nulliparous women having a vaginal delivery over the same period (5% [98\/1981] versus 3.5% [1216\/34\u00a0496], <jats:italic>P\u00a0<\/jats:italic>=\u00a00.001, odds ratio 1.4, 95% CI 1.15\u20131.75). The rate of instrumental delivery in woman having a VBAC was 39% (771\/1981). On multiple logistic regression analysis an increased rate of instrumental delivery was a strong predictor of sphincter injury (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.03, odds ratio 1.15, 95% CI 1.01\u20131.3). When the first labours of women with sphincter injury in the VBAC group were examined, 70% (60\/86) had been in labour before undergoing their caesarean delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The incidence of anal sphincter injury in women undergoing VBAC is 5% and birthweight is the strongest predictor of this. The rate of instrumental delivery in this group was also increased.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12706","type":"journal-article","created":{"date-parts":[[2014,3,13]],"date-time":"2014-03-13T06:52:41Z","timestamp":1394693561000},"page":"1515-1520","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Are women having a vaginal birth after a previous caesarean delivery at increased risk of anal sphincter injury?"],"prefix":"10.1111","volume":"121","author":[{"given":"MP","family":"Hehir","sequence":"first","affiliation":[{"name":"National Maternity Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"National Maternity Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Cassidy","sequence":"additional","affiliation":[{"name":"National Maternity Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Murphy","sequence":"additional","affiliation":[{"name":"National Maternity Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"O'Herlihy","sequence":"additional","affiliation":[{"name":"School of Medicine and Medical Science University College Dublin Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,3,13]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02237089"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199312233292601"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.108880"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/jmf.16.5.271.274"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200108000-00008"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2003.09.030"},{"key":"e_1_2_7_8_1","first-page":"21","article-title":"Anal sphincter tears at vaginal delivery: risk factors and clinical outcome of primary repair","volume":"941","author":"Zetterstrom J","year":"1999","journal-title":"Obstet Gynecol"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181e2f50b"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016340903295626"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1980.tb04569.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70104-3"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-012-2006-6"},{"key":"e_1_2_7_14_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.ajog.2006.10.893","article-title":"Risk factors for primary and subsequent anal sphincter lacerations: a comparison of cohorts by parity and prior mode of delivery","volume":"196","author":"Lowder JL","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.06.035"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.09.029"},{"key":"e_1_2_7_17_1","first-page":"285","article-title":"Centers for Disease Control and Prevention (CDC)","volume":"1993","author":"CDC. 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