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Am J Perinatol 2022; 39(07): 750-758
DOI: 10.1055/s-0040-1717099
Original Article

Is there an Association between Vaginal Birth after Cesarean Prediction and Obstetric Anal Sphincter Injury?

Oluwateniola Brown 
1   Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
,
Douglas Luchristt
1   Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
,
Emily S. Miller
2   Division of Maternal Fetal Medicine, Northwestern University, Chicago, Illinois
,
Mahati Pidaparti
3   Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Julia Geynisman-Tan
1   Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
,
Kimberly Kenton
1   Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
,
Christina Lewicky-Gaupp
1   Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
› Author Affiliations Funding The research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences (grant number: UL1TR001422). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Abstract

Objective This study aimed to estimate whether there is an association between the predicted probability of vaginal birth after cesarean delivery (VBAC) and the occurrence of obstetric anal sphincter injuries (OASIS).

Study Design This was a single-site retrospective cohort study of all women with a singleton vaginal birth after a previous cesarean section between January 2011 and December 2016. Women were divided into four ordinal groupings by the predicted probability of achieving vaginal birth after cesarean using the Maternal–Fetal Medicine Units Network VBAC calculator (less than 41%, 40.1–60%, 60.1–80%, and greater than 80%). The primary outcome was OASIS, defined as a 3rd or 4th degree perineal laceration. Bivariable and multivariable analyses were used to examine the association between predicted VBAC probability and OASIS.

Results In total, 1,411 women met inclusion criteria and 73 (5.2%) sustained OASIS. The median predicted probability of VBAC was lower in women with OASIS compared with those without OASIS (60% [interquartile range {IQR}: 48–70%] vs. 66% (IQR: 52–80%), p = 0.02]. On bivariable and multivariable logistic regression, predicted probability of VBAC was associated with increased odds of OASIS (less than 41% probability: adjusted odds ratio [aOR]: 3.18, 95% confidence interval [CI]: 0.90–11.21; 41–60% probability: aOR: 3.76, 95% CI: 1.34–10.57; 61–80% probability aOR: 3.47, 95% CI: 1.25–9.69) relative to women with a predicted probability of VBAC of greater than 80%.

Conclusion Having a lower predicted probability of VBAC is associated with an increased risk of OASIS at the time of a VBAC relative to those with greater than 80% predicted probability. Incorporation of this aspect of maternal morbidity may inform risk-stratification at the time of trial of labor after cesarean, as well as the choice of performing an operative vaginal delivery.

Key Points

  • Predicted probability of VBAC is associated with OASIS.

  • Low predicted probability of VBAC is associated with increased odds of OASIS.

  • Forceps delivery was associated with the highest odds of OASIS.

Keywords

OASIS - VBAC - trial of labor

Supplementary Material



Publication History

Received: 09 May 2020

Accepted: 12 August 2020

Article published online:
29 September 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Grobman WA, Lai Y, Landon MB. et al; National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Development of a nomogram for prediction of vaginal birth after cesarean delivery. Obstet Gynecol 2007; 109 (04) 806-812
    CrossrefPubMedGoogle Scholar
  • 2 Metz TD, Allshouse AA, Faucett AM, Grobman WA. Validation of a vaginal birth after cesarean delivery prediction model in women with two prior cesarean deliveries. Obstet Gynecol 2015; 125 (04) 948-952
    CrossrefPubMedGoogle Scholar
  • 3 Mardy AH, Ananth CV, Grobman WA, Gyamfi-Bannerman C. A prediction model of vaginal birth after cesarean in the preterm period. Am J Obstet Gynecol 2016; 215 (04) 513.e1-513.e7
    CrossrefPubMedGoogle Scholar
  • 4 Grobman WA, Lai Y, Landon MB. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?. Am J Obstet Gynecol 2009; 200 (01) 56.e1-56.e6
    CrossrefPubMedGoogle Scholar
  • 5 Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 2003; 189 (06) 1543-1549 , discussion 1549–1550
    CrossrefPubMedGoogle Scholar
  • 6 Leijonhufvud Å, Lundholm C, Cnattingius S, Granath F, Andolf E, Altman D. Risk of surgically managed pelvic floor dysfunction in relation to age at first delivery. Am J Obstet Gynecol 2012; 207 (04) 303.e1-303.e7
    CrossrefPubMedGoogle Scholar
  • 7 Handa VL, Blomquist JL, McDermott KC, Friedman S, Muñoz A. Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol 2012; 119 (2 Pt 1): 233-239
    CrossrefPubMedGoogle Scholar
  • 8 Blomquist JL, McDermott K, Handa VL. Pelvic pain and mode of delivery. Am J Obstet Gynecol 2014; 210 (05) 423.e1-423.e6
    CrossrefPubMedGoogle Scholar
  • 9 Lewicky-Gaupp C, Leader-Cramer A, Johnson LL, Kenton K, Gossett DR. Wound complications after obstetric anal sphincter injuries. Obstet Gynecol 2015; 125 (05) 1088-1093
    CrossrefPubMedGoogle Scholar
  • 10 Ramm O, Woo VG, Hung YY, Chen HC, Ritterman Weintraub ML. Risk factors for the development of obstetric anal sphincter injuries in modern obstetric practice. Obstet Gynecol 2018; 131 (02) 290-296
    CrossrefPubMedGoogle Scholar
  • 11 Richter HE, Brumfield CG, Cliver SP, Burgio KL, Neely CL, Varner RE. Risk factors associated with anal sphincter tear: a comparison of primiparous patients, vaginal births after cesarean deliveries, and patients with previous vaginal delivery. Am J Obstet Gynecol 2002; 187 (05) 1194-1198
    CrossrefPubMedGoogle Scholar
  • 12 Räisänen S, Vehviläinen-Julkunen K, Cartwright R, Gissler M, Heinonen S. A prior cesarean section and incidence of obstetric anal sphincter injury. Int Urogynecol J Pelvic Floor Dysfunct 2013; 24 (08) 1331-1339
    CrossrefPubMedGoogle Scholar
  • 13 Hehir MP, Fitzpatrick M, Cassidy M, Murphy M, O'Herlihy C. Are women having a vaginal birth after a previous caesarean delivery at increased risk of anal sphincter injury?. BJOG 2014; 121 (12) 1515-1520
    CrossrefPubMedGoogle Scholar
  • 14 Ampt AJ, Patterson JA, Roberts CL, Ford JB. Obstetric anal sphincter injury rates among primiparous women with different modes of vaginal delivery. Int J Gynaecol Obstet 2015; 131 (03) 260-264
    CrossrefPubMedGoogle Scholar
  • 15 Lowder JL, Burrows LJ, Krohn MA, Weber AM. Risk factors for primary and subsequent anal sphincter lacerations: a comparison of cohorts by parity and prior mode of delivery. Am J Obstet Gynecol 2007; 196 (04) 344.e1-344.e5
    CrossrefPubMedGoogle Scholar
  • 16 Pergialiotis V, Vlachos D, Protopapas A, Pappa K, Vlachos G. Risk factors for severe perineal lacerations during childbirth. Int J Gynaecol Obstet 2014; 125 (01) 6-14
    CrossrefPubMedGoogle Scholar
  • 17 Elvander C, Ahlberg M, Thies-Lagergren L, Cnattingius S, Stephansson O. Birth position and obstetric anal sphincter injury: a population-based study of 113 000 spontaneous births. BMC Pregnancy Childbirth 2015; 15: 252
    CrossrefPubMedGoogle Scholar
  • 18 Jangö H, Langhoff-Roos J, Rosthøj S, Sakse A. Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population-based cohort study. Am J Obstet Gynecol 2014; 210 (01) 59.e1-59.e6
    CrossrefPubMedGoogle Scholar
  • 19 Vale de Castro Monteiro M, Pereira GM, Aguiar RA, Azevedo RL, Correia-Junior MD, Reis ZS. Risk factors for severe obstetric perineal lacerations. Int Urogynecol J Pelvic Floor Dysfunct 2016; 27 (01) 61-67
    CrossrefPubMedGoogle Scholar
  • 20 Jha S, Parker V. Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis. Int Urogynecol J Pelvic Floor Dysfunct 2016; 27 (06) 849-857
    CrossrefPubMedGoogle Scholar
  • 21 Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2009; (01) CD000081
    PubMedGoogle Scholar
  • 22 Meister MR, Cahill AG, Conner SN, Woolfolk CL, Lowder JL. Predicting obstetric anal sphincter injuries in a modern obstetric population. Am J Obstet Gynecol 2016; 215 (03) 310.e1-310.e7
    CrossrefPubMedGoogle Scholar
  • 23 McPherson KC, Beggs AD, Sultan AH, Thakar R. Can the risk of obstetric anal sphincter injuries (OASIs) be predicted using a risk-scoring system?. BMC Res Notes 2014; 7: 471
    CrossrefPubMedGoogle Scholar
  • 24 Williams A, Tincello DG, White S, Adams EJ, Alfirevic Z, Richmond DH. Risk scoring system for prediction of obstetric anal sphincter injury. BJOG 2005; 112 (08) 1066-1069
    CrossrefPubMedGoogle Scholar
  • 25 Gossett DR, Gilchrist-Scott D, Wayne DB, Gerber SE. Simulation training for forceps-assisted vaginal delivery and rates of maternal perineal trauma. Obstet Gynecol 2016; 128 (03) 429-435
    CrossrefPubMedGoogle Scholar
  • 26 D'Souza JC, Monga A, Tincello DG. Risk factors for obstetric anal sphincter injuries at vaginal birth after caesarean: a retrospective cohort study. Int Urogynecol J Pelvic Floor Dysfunct 2019; 30 (10) 1747-1753
    CrossrefPubMedGoogle Scholar
  • 27 Chiu K, McKay E, Fazzari M, Leegant A. Risks and associations of third- and fourth-degree lacerations: an urban single center experience. Female Pelvic MedReconst Surgery 2021; 27 (01) e146-e151
    CrossrefPubMedGoogle Scholar
  • 28 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 205: vaginal birth after cesarean delivery. Obstet Gynecol 2019; 133 (02) e110-e127
    CrossrefPubMedGoogle Scholar