Obstetrical anal sphincter laceration and anal incontinence 5-10 years after childbirth.
ABSTRACT OBJECTIVE: The purpose of this study was to investigate the long-term impact of anal sphincter laceration on anal incontinence. STUDY DESIGN: Five to 10 years after first delivery, anal incontinence and other bowel symptoms were measured with the Epidemiology of Prolapse and Incontinence Questionnaire and the short form of the Colorectal-Anal Impact Questionnaire. Obstetric exposures were assessed with review of hospital records. Symptoms and quality-of-life impact were compared among 90 women with at least 1 anal sphincter laceration, 320 women who delivered vaginally without sphincter laceration, and 527 women who delivered by cesarean delivery. RESULTS: Women who sustained an anal sphincter laceration were most likely to report anal incontinence (odds ratio, 2.32; 95% confidence interval, 1.27-4.26) and reported the greatest negative impact on quality of life. Anal incontinence and quality-of-life scores were similar between women who delivered by cesarean section and those who delivered vaginally without sphincter laceration. CONCLUSION: Anal sphincter laceration is associated with anal incontinence 5-10 years after delivery.
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ABSTRACT: Anal incontinence is nine times more prevalent in women than in men due to obstetric anal sphincter injury (OASI). OASI is linked to midline episiotomies and mediolateral episiotomies with post-delivery angles of <30 and >60 degrees. Studies show that doctors and midwives are unable to correctly "eyeball" the safe angle required due to perineal stretching by the fetal head at crowning. A new scissor instrument (Episcissors-60) was devised to allow cutting a mediolateral episiotomy at a fixed angle of 60 degrees from the perineal midline. Scissors with a marker guide limb pointing towards the anus were devised, ensuring an angle of 60 degrees between the scissor blades and the guide limb. This device was initially tested in models. Post-delivery angles were recorded on transparencies and analyzed by an author blinded to clinical details. Accoucheurs were asked to rate the ease of use on a 5-point scale. Of the 17 women, 14 delivered with ventouse, two with forceps, and one with sequential ventouse-forceps. Indications for instrumental delivery were suboptimal cardiotocogram and/or prolonged second stage of labor. Mean birth weight was 3.41 (2.92-4.12) kg. A mean post-delivery angle of 42.4±7 (range 30-60, median 43) degrees (95% confidence interval 38.8-46) was achieved with the Episcissors-60 instrument. Eighty-eight percent of clinicians agreed or strongly agreed that the scissors were easy to use. The Episcissors-60 delivered a consistent post-delivery angle of 43 degrees. They could replace "eyeballing" when performing mediolateral episiotomies and form part of a preventative strategy to reduce OASI.Medical Devices: Evidence and Research 01/2014; 7:23-8.
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ABSTRACT: Objective. To estimate the association between maternal obesity and risk of three different degrees of severity of obstetric anal sphincter injury. Methods. The study population consisted of 436,482 primiparous women with singleton term vaginal cephalic births between 1998 and 2011 identified in the Swedish Medical Birth Registry. Women were grouped into six categories of BMI. BMI 18.5-24.9 was set as reference. Primary outcome was third-degree perineal laceration, partial or total, and fourth-degree perineal laceration. Adjustments were made for year of delivery, maternal age, fetal head position at delivery, infant birth weight and instrumental delivery. Results. The overall prevalence of third- or four-degree anal sphincter injury was 6.6% (partial anal sphincter injury 4.6%, total anal sphincter injury 1.2%, unclassified as either partial and total 0.2%, or fourth degree lacerations 0.6%). The risk for a partial, total, or a fourth-degree anal sphincter injury decreased with increasing maternal BMI most pronounced for total anal sphincter injury where the risk among morbidly obese women was half that of normal weight women, OR 0.47 95% CI 0.28-0.78. Conclusion. Obese women had a favourable outcome compared to normal weight women concerning serious pelvic floor damages at birth.BioMed Research International 01/2014; 2014:395803. · 2.88 Impact Factor
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ABSTRACT: Abstract OBJECTIVE: To assess the risk of recurrence of third- and fourth-degree perineal tears (34DPT) and to determine whether previous 34DPT is an independent risk factor for 34DPT in subsequent deliveries. METHODS: The study group included all women who had a vaginal delivery complicated by 34DPT (2000- 2012, N=356) and subsequently delivered again in the same medical center (N=204). The rate of recurrence of 34DPT was compared with a control group of women who had a previous vaginal delivery not complicated by 34DPT (N=58,581) and had a subsequent delivery in the same time period (N=23,045). RESULTS: Women in the past-34DPT group had a higher rate of CS (18.6% vs. 10.1%, p<0.001), fetal head in occiput-posterior position (2.5% vs. 0.7%, p=0.004) and mediolateral episiotomy (25.5% vs. 19.4%, p=0.03). Women in the past-34DPT group had a higher rate of 34DPT in the subsequent delivery (2.0% vs. 0.3%, p<0.001). The rate of recurrence of 34DPT was considerably higher among women with past fourth-degree tear vs. women with past third-degree tear (22.2% vs. 1.0%, p<0.001). 34DPT in previous pregnancy is independently associated with increased risk of 34DPT in subsequent delivery (OR=4.6, 95%-CI 1.3-15.3). CONCLUSION: Women who experienced 34DPT in their previous pregnancy have an increased risk for recurrence of 34DPT in subsequent pregnancy, especially in cases of past fourth-degree tears.The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 05/2013; · 1.36 Impact Factor