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Among women who had a vaginal delivery at second birth, the rate of third\u2010 or fourth\u2010degree tears was 7.2% for women with a third\u2010 or fourth\u2010degree tear at first birth, compared with 1.3% for women without (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 5.5, 95% CI 5.2\u20135.9).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The risk of a severe perineal tear is increased five\u2010fold in women who had a third\u2010 or fourth\u2010degree tear in their first delivery. This increased risk should be taken into account when decisions about mode of delivery are made.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12886","type":"journal-article","created":{"date-parts":[[2014,7,9]],"date-time":"2014-07-09T05:22:49Z","timestamp":1404883369000},"page":"1695-1703","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Impact of third\u2010 and fourth\u2010degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study"],"prefix":"10.1111","volume":"121","author":[{"given":"LC","family":"Edozien","sequence":"first","affiliation":[{"name":"Maternal and Fetal Health Research Manchester Academic Health Science Centre University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"Gurol\u2010Urganci","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London UK"},{"name":"Office for Research and Clinical Audit Lindsay Stewart R&amp;D Centre Royal College of Obstetricians and Gynaecologists (RCOG) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DA","family":"Cromwell","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"EJ","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Urogynaecology Liverpool Women's NHS Foundation Trust Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DH","family":"Richmond","sequence":"additional","affiliation":[{"name":"Office for Research and Clinical Audit Lindsay Stewart R&amp;D Centre Royal College of Obstetricians and Gynaecologists (RCOG) London UK"},{"name":"Department of Urogynaecology Liverpool Women's NHS Foundation Trust Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"TA","family":"Mahmood","sequence":"additional","affiliation":[{"name":"Office for Research and Clinical Audit Lindsay Stewart R&amp;D Centre Royal College of Obstetricians and Gynaecologists (RCOG) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JH","family":"van der Meulen","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,7,9]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.04.033"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)31018-0"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12363"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000151114.35498.e9"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2011.03150.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00138.x"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03486.x"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-89"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767050600921307"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(03)00008-3"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.2001.080003229.x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.10.893"},{"key":"e_1_2_6_14_1","first-page":"333","article-title":"The association between perineal trauma and spontaneous perineal tears","volume":"50","author":"Martin S","year":"2001","journal-title":"J Fam Pract"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(98)00207-0"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-199906000-00025"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2013.806902"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2003.09.030"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01554.x"},{"key":"e_1_2_6_20_1","unstructured":"HSCIC.The processing cycle and HES data quality.2014[www.hscic.gov.uk\/article\/1825\/The-processing-cycle-and-HES-data-quality]. 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