scholarly journals Obstetric anal sphincter injury by maternal origin and length of residence: a nation-wide cohort study

2021 ◽  
Author(s):  
Ingvil Sorbye ◽  
Sukhjeet Bains ◽  
Siri Vangen ◽  
Johanne Sundby ◽  
Benedikte Lindskog ◽  
...  
Keyword(s):  
Cohort Study ◽  
Anal Sphincter ◽  
Sub Saharan Africa ◽  
Foreign Born ◽  
Maternal Origin ◽  
Length Of Residence ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Sub Saharan ◽  
Primiparous Women

Objective: To estimate the association between maternal origin and obstetric anal sphincter injury (OASI), and assess if associations differed by length of residence. Design: Population-based cohort study. Setting: The Medical Birth Registry of Norway. Population: Primiparous women with vaginal livebirth of a singleton cephalic fetus between 2008 and 2017 (n=188 658). Methods: Multivariable logistic regression models estimated aORs for OASI with 95% CI by maternal region of origin and birthplace. We stratified models on length of residence and paternal birthplace. Main outcome measures: OASI. Results: Overall 6 373 cases of OASI were identified (3.4% of total cohort). Women from South Asia were most likely to experience OASI (6.2%; aOR 2.24, 95% CI 1.93–2.60), followed by those from Southeast/East Asian/Pacific (5.7%; 1.83, 1.64–2.04), and Sub-Saharan Africa (5.2%; 1.97, 1.72–2.26), compared to women originating from Norway. Among women born in the same region, those with short length of residence in Norway (0–4 years), showed higher odds of OASI. Migrant women across most regions of origin had reduced risk of OASI if they had a Norwegian compared to foreign-born partner. Conclusions: Primiparous women from Asian regions and Sub-Saharan Africa had up to two-fold risk of OASI, compared to women originating from Norway. Migrants with short residence and those with a foreign-born partner had higher risk of OASI, implying that some of the risk differential is due to sociocultural factors. Some migrants, especially new arrivals, may benefit from special attention during labour to reduce morbidity and achieve equitable outcomes.

scholarly journals Risk of obstetric anal sphincter injury among women who birth vaginally after a prior caesarean section: A state-wide cohort study

2021 ◽  
Author(s):  
Jessica Uebergang ◽  
Richard Hiscock ◽  
Roxanne Hastie ◽  
Anna Middleton ◽  
Natasha Pritchard ◽  
...  
Keyword(s):  
Cohort Study ◽  
Caesarean Section ◽  
Anal Sphincter ◽  
Vaginal Birth ◽  
Obstetric Anal Sphincter Injury ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Increased Risk ◽  
Primiparous Women ◽  
Vaginal Birth After Caesarean

Objective: 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 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. Design: State-wide retrospective cohort study. Setting: Victoria, Australia. Population: All births (455,000) between 2009-2014. Methods: The risk of severe perineal injury between first vaginal birth and first vaginal birth after previous caesarean section was compared, after adjustment for potential confounding variables. Covariates were examined using logistic regression for categorical data and Wilcoxon rank-sum test for continuous data. Missing data were handled using multiple imputation; the analysis was performed using regression adjustment and Stata v16 multiple imputation and teffects suites. Results: Women having a VBAC (n=5,429) were significantly more likely than primiparous women (n=123,353) to sustain a 3rd or 4th degree tear during vaginal birth (7.1 vs 5.7%, p<0.001). 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 (relative risk 1.21 (95%CI 1.07 – 1.38)). Conclusions: Women having their first vaginal birth after caesarean section have a significant increased risk of sustaining a 3rd or 4th degree tear, compared with primiparous women having a vaginal birth. Patient counselling and professional guidelines should reflect this increased risk.

scholarly journals Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study

2021 ◽  
Vol 18 (11) ◽  
pp. 5938
Author(s):  
Fatou Jatta ◽  
Johanne Sundby ◽  
Siri Vangen ◽  
Benedikte Victoria Lindskog ◽  
Ingvil Krarup Sørbye ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Caesarean Section ◽  
Body Mass ◽  
Normal Weight ◽  
Sub Saharan Africa ◽  
Asia Pacific ◽  
Adjusted Relative Risk ◽  
Maternal Origin ◽  
Length Of Residence ◽  
Sub Saharan

Aims: To explore the association between maternal origin and birthplace, and caesarean section (CS) by pre-pregnancy body mass index (BMI) and length of residence. Methods: We linked records from 118,459 primiparous women in the Medical Birth Registry of Norway between 2013 and 2017 with data from the National Population Register. We categorized pre-pregnancy BMI (kg/m2) into underweight (<18.5), normal weight (18.5–24.9) and overweight/obese (≥25). Multinomial regression analysis estimated crude and adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) for emergency and elective CS. Results: Compared to normal weight women from Norway, women from Sub-Saharan Africa and Southeast Asia/Pacific had a decreased risk of elective CS (aRRR = 0.57, 95% CI 0.37–0.87 and aRRR = 0.56, 0.41–0.77, respectively). Overweight/obese women from Europe/Central Asia had the highest risk of elective CS (aRRR = 1.42, 1.09–1.86). Both normal weight and overweight/obese Sub-Saharan African women had the highest risks of emergency CS (aRRR = 2.61, 2.28-2.99; 2.18, 1.81-2.63, respectively). Compared to women from high-income countries, the risk of elective CS was increasing with a longer length of residence among European/Central Asian women. Newly arrived migrants from Sub-Saharan Africa had the highest risk of emergency CS. Conclusion: Women from Sub-Saharan Africa had more than two times the risk of emergency CS compared to women originating from Norway, regardless of pre-pregnancy BMI.

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