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The increase in second degree tears was balanced by fewer episiotomies.
A Cochrane review evaluating effects of birth position in women without an epidural reported an increase in second degree tears, (Relative Risk (RR) 1.35, 95% CI: 1.20, 1.51) and a corresponding reduction in episiotomy (RR 0.79, 95% CI: 0.70, 0.90), in women who were in an upright position compared with women in supine positions [ 28].
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Although an association between birth seat position and increase in second-degree tears previously has been reported [ 8], the association between birth seat and increased risk of OASIS in parous women found in our study is a novel and important finding.
Aside from the major environmental risk factor of tobacco use, and the un-modifiable risk factors of advancing age and male gender, there is compelling evidence for the genetic contribution to the pathogenesis of AAA, with up to ten-fold increased risk in first degree relatives of those with AAA.
The risk of coeliac disease is increased in first-degree relatives, certain syndromes including Down syndrome and autoimmune disorders.
The concentrations and frequencies of all anti-CCP and RF isotypes were significantly increased in first-degree relatives and patients with RA compared with unrelated healthy controls.
The concentrations of ACPA isotypes IgG, IgM and IgA and RF isotypes IgM and IgA were significantly increased in first-degree relatives compared with controls, and were further increased in patients with RA (table 1).
There is also a clear increased familial risk of NPC and salivary gland carcinoma among the Inuit, with an eight-fold increased risk in first-degree relatives, which is among the highest reported for any cancer (Goldgar et al, 1994; Friborg et al, 2005).
Bipolar affective disorder (BD) has a life-time risk of ∼1% in the general population and a 10-fold increased risk in first-degree relatives (1).
Cryptorchidism is a common congenital anomaly that shows familial clustering and increased prevalence in first-degree relatives, suggesting that genetic factors contribute to the etiology.
Population-based case control studies have described a two to three-fold increased risk in first-degree relatives of ovarian cancer patients (Godard et al, 1998; Stratton et al, 1998) and heritability is estimated to be approximately 22% (Lichtenstein et al, 2000).
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