Incidence of third-degree perineal tears in labour and outcome after primary repair

Abstract

The incidence and outcome of third-degree tears following 16,583 vaginal deliveries were prospectively assessed over a 5.5-year period. Ninety-three deliveries (0.56 per cent) were complicated by a third-degree tear and the patients underwent primary repair. Eighty-one patients were reviewed 3 months postpartum at a colorectal clinic. Third-degree tears were significantly more common in primigravidae and mothers with higher birth-weight babies. They were significantly associated with the use of forceps and were not prevented by episiotomy. Of the 81 patients reviewed, 30 had an abnormal anorectal examination. Six patients (7 per cent) were incontinent of faeces. A further ten (12 per cent) were incontinent of flatus only. The overall incidence of faecal incontinence was 0.04 per cent. An important group of women with significant subclinical sphincter injury was identified. Obstetric trauma causes significant anorectal dysfunction and patients with third-degree tears require assessment by a colorectal specialist.

The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence

“…In agreement with other research teams we found a high frequency of endosonographic sphincter defects after primarily sutured sphincter tears 4,8,20,25 . By using an endosonographic defect scoring system we quantified the sphincter damage and described its change over time.…”

“…According to published studies, most women with anal incontinence after an obstetric sphincter tear are incontinent for gas only (gas incontinence/stool incontinence ratio of 5 : 1) 8,12,21,28 . In a 30-year retrospective study of women in three groups (obstetric anal sphincter tear, episiotomy, Cesarean delivery) 16 a surprisingly large number of middle-aged women had anal incontinence.…”

Risk factors for anal sphincter disruption during child birth

“…The gestational age and the maternal age at delivery were not shown to be significant risk factors (p= NS). Similar studies conducted by Sultan et al [13], Walsh et al [15] and Fenner et al [16] have also demonstrated forceps delivery, primiparity, foetal birth weight over 4 kg and delay in the second stage of labour to be risk factors. In addition, Sultan et al [13], in their study, demonstrated that persistent occipitoposterior position to be a significant risk factor.…”

Management of the Perineum during Delivery with the Kiwi Omnicup: Effects of Mediolateral Episiotomy on Anal Sphincter Tears in Nulliparous Women

“…The avoidance of severe perineal trauma is of clinical importance because of the long-term morbidity for the new mothers, including perineal pain, dyspa- 175 reunia and anal incontinence, of which foecal incontinence is a particularly devastating complication [20]. As vacuum delivery is still a well-known risk factor for anal sphincter tears, it is of outstanding interest to manage the perineum during this procedure in the best way.…”