{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T03:32:13Z","timestamp":1785900733328,"version":"3.56.0"},"reference-count":44,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T00:00:00Z","timestamp":1641427200000},"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":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Vaginal birth after caesarean (VBAC) has been suggested to be associated with an increased risk of obstetric anal sphincter injury (compared with primiparous women who birth vaginally). However, prior studies have been small or have used outdated methodology. We set out to validate whether the risk of obstetric anal sphincter injury among women having their first VBAC is greater than that among primiparous women having a vaginal birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>State\u2010wide retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Victoria, Australia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>All births (455\u00a0000) between 2009 and 2014.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The risk of severe perineal injury between the first vaginal birth and the first VBAC was compared, after adjustment for potential confounding variables. Covariates were examined using logistic regression for categorical data and the Wilcoxon rank\u2010sum test for continuous data. Missing data were handled using multiple imputation; the analysis was performed using regression adjustment and <jats:sc>stata<\/jats:sc>\u00a016 multiple imputation and suite of effects commands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Women having a VBAC (<jats:italic>n<\/jats:italic>\u00a0=\u00a05429) were significantly more likely than primiparous women (<jats:italic>n<\/jats:italic>\u00a0=\u00a0123\u00a0353) to sustain a third\u2010 or fourth\u2010degree tear during vaginal birth (7.1 versus 5.7%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). After adjustment for mode of birth, body mass index, maternal age, infant birthweight, episiotomy and epidural, there was a 21% increased risk of severe perineal injury (RR\u00a01.21, 95%\u00a0CI 1.07\u20131.38).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Women having their first VBAC have a significantly increased risk of sustaining a third\u2010 or fourth\u2010degree tear, compared with primiparous women having a vaginal birth. Patient counselling and professional guidelines should reflect this increased risk.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17063","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T09:44:10Z","timestamp":1639647850000},"page":"1325-1332","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Risk of obstetric anal sphincter injury among women who birth vaginally after a prior caesarean section: A state\u2010wide cohort study"],"prefix":"10.1111","volume":"129","author":[{"given":"Jessica","family":"Uebergang","sequence":"first","affiliation":[{"name":"Mercy Perinatal Mercy Hospital for Women  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hiscock","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Melbourne  Melbourne Victoria 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