Childbirth Acquired Perineal Trauma (CHAPTER) study: A cohort study investigating health outcomes after childbirth‐related perineal trauma
5 affiliations
- 1Department of Applied Health Sciences University of Birmingham Birmingham UK
- 2Birmingham Women's Hospital Birmingham UK
- 3National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre Birmingham UK
- 4Department of Population Health Sciences King's College London London UK
- 5Health Data Research UK (HDRUK) London UK
Abstract
Introduction: Childbirth‐related perineal trauma (CRPT) is the most common complication of vaginal birth, yet its associations with mental health and other health outcomes remain poorly described. This study examined the annual incidence of recorded CRPT by tear degree and investigated its association with mental health and other health outcomes.
Material and Methods: We conducted a retrospective cohort study using Clinical Practice Research Datalink Aurum primary care data linked with Hospital Episode Statistics, including women aged ≥16 years who had given birth vaginally between 1st January 2005 and 31st December 2019. Exposure was defined as recorded CRPT of any degree including episiotomy. Annual incidence of CRPT was calculated as a percentage of all births. Cox proportional hazards regression models compared short‐, medium‐, and long‐term (<1 year, 1–5 years, and >5 years post‐childbirth) outcomes between women with and without CRPT. We conducted subgroup analyses by degree of tear and in women with spontaneous vertex births, and a sensitivity analysis restricted to first birth.
Results: Incidence of recorded CRPT increased from 43.4% to 48.8% between 2005 and 2019. Compared to women without CRPT, those with CRPT had a higher risk of anxiety (aHR 1.19, 95%CI 1.17, 1.22) or depression (aHR 1.23, 95%CI 1.21, 1.25) within 1 year postpartum, with elevated risks persisting beyond 5 years and across all degrees of tear. Women with 1st/2nd degree tears or episiotomy had a higher hazard of post‐traumatic stress disorder 1–5 years postpartum. CRPT was associated with increased hazard of urinary incontinence, dyspareunia, reduced libido, vaginal discharge, general and perineal pain, and prolapse in all follow‐up periods. Fecal incontinence was increased in women with episiotomy or 3rd/4th degree tears, persisting long‐term for severe tears. CRPT was associated with 32% higher risk of antibiotic prescription compared to no CRPT (OR 1.32, 95%CI 1.30, 1.33) within 6 weeks postpartum.
Conclusions: Recorded CRPT was associated with increased risks of diagnosed anxiety and depression in short‐, medium‐ and long‐term post‐childbirth, irrespective of tear severity, as well as higher risks of other adverse outcomes, including urinary incontinence, pain, and sexual dysfunction. Addressing CRPT should be prioritized to improve women's health and well‐being.
Related
- Perineal Body Reconstruction for Anal Sphincter Insufficiency Following Obstetric Perineal Body Injury: Morphology-based Classification and Type-stratified Outcomes in 42 Cases.
- Treatment patterns and outcomes in perineal primary vulvar cancer—a population‐based Swedish cohort study
- Surgical Approaches to Perineal Reconstruction: A Narrative Review
- Comments on "Mini-invasive J-colpo-perineo-rectopexy with titanized polypropylene mesh for global perineal descent: a technical note".
- Bladder Urothelial Carcinoma Diagnosed by Perineal Cutaneous Biopsy: A Case Report
BibTeX
@article{wang2026childbirth,
title = {{Childbirth Acquired Perineal Trauma (CHAPTER) study: A cohort study investigating health outcomes after childbirth‐related perineal trauma}},
author = {Zhaonan Wang and Luyuan Tan and Rebecca Man and Christine MacArthur and R. Katie Morris and Krishnarajah Nirantharakumar and Arturo Gonzalez‐Izquierdo and Victoria Hodgetts Morton and Nicola J. Adderley and Laura Jones and Laura Jones and Sara Webb and John Maltby and Sarah Hillman and Alice Sitch and Olalekan Lee Aiyegbusi and Marian Knight and Susan Tohill and Jane Whitehurst},
journal = {Acta Obstetricia et Gynecologica Scandinavica},
year = {2026},
month = jul,
doi = {10.1111/aogs.70320},
url = {https://doi.org/10.1111/aogs.70320},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Childbirth Acquired Perineal Trauma (CHAPTER) study: A cohort study investigating health outcomes after childbirth‐related perineal trauma
AU - Zhaonan Wang
AU - Luyuan Tan
AU - Rebecca Man
AU - Christine MacArthur
AU - R. Katie Morris
AU - Krishnarajah Nirantharakumar
AU - Arturo Gonzalez‐Izquierdo
AU - Victoria Hodgetts Morton
AU - Nicola J. Adderley
AU - Laura Jones
AU - Laura Jones
AU - Sara Webb
AU - John Maltby
AU - Sarah Hillman
AU - Alice Sitch
AU - Olalekan Lee Aiyegbusi
AU - Marian Knight
AU - Susan Tohill
AU - Jane Whitehurst
PY - 2026
DA - 2026/07/16
JO - Acta Obstetricia et Gynecologica Scandinavica
DO - 10.1111/aogs.70320
UR - https://doi.org/10.1111/aogs.70320
AB - Introduction: Childbirth‐related perineal trauma (CRPT) is the most common complication of vaginal birth, yet its associations with mental health and other health outcomes remain poorly described. This study examined the annual incidence of recorded CRPT by tear degree and investigated its association with mental health and other health outcomes. Material and Methods: We conducted a retrospective cohort study using Clinical Practice Research Datalink Aurum primary care data linked with Hospital Episode Statistics, including women aged ≥16 years who had given birth vaginally between 1st January 2005 and 31st December 2019. Exposure was defined as recorded CRPT of any degree including episiotomy. Annual incidence of CRPT was calculated as a percentage of all births. Cox proportional hazards regression models compared short‐, medium‐, and long‐term (<1 year, 1–5 years, and >5 years post‐childbirth) outcomes between women with and without CRPT. We conducted subgroup analyses by degree of tear and in women with spontaneous vertex births, and a sensitivity analysis restricted to first birth. Results: Incidence of recorded CRPT increased from 43.4% to 48.8% between 2005 and 2019. Compared to women without CRPT, those with CRPT had a higher risk of anxiety (aHR 1.19, 95%CI 1.17, 1.22) or depression (aHR 1.23, 95%CI 1.21, 1.25) within 1 year postpartum, with elevated risks persisting beyond 5 years and across all degrees of tear. Women with 1st/2nd degree tears or episiotomy had a higher hazard of post‐traumatic stress disorder 1–5 years postpartum. CRPT was associated with increased hazard of urinary incontinence, dyspareunia, reduced libido, vaginal discharge, general and perineal pain, and prolapse in all follow‐up periods. Fecal incontinence was increased in women with episiotomy or 3rd/4th degree tears, persisting long‐term for severe tears. CRPT was associated with 32% higher risk of antibiotic prescription compared to no CRPT (OR 1.32, 95%CI 1.30, 1.33) within 6 weeks postpartum. Conclusions: Recorded CRPT was associated with increased risks of diagnosed anxiety and depression in short‐, medium‐ and long‐term post‐childbirth, irrespective of tear severity, as well as higher risks of other adverse outcomes, including urinary incontinence, pain, and sexual dysfunction. Addressing CRPT should be prioritized to improve women's health and well‐being.
SN - 0001-6349
SN - 1600-0412
ER -