Women and birth : journal of the Australian College of Midwives
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To determine rates and risk factors for third and fourth degree perineal tears (severe perineal trauma) in a Western Australian context. ⋯ Parity differences in risk factors such as episiotomy, infant weight, OP delivery, gestational diabetes and prolonged second stage warrant investigation into clinical management. Although rates differ internationally, and replication evidence has confirmed consistency for certain demographic and obstetric factors, the development of internationally endorsed clinical guidelines and further research around interventions to protect the perineum are recommended.