Risk factors for rupture of the anal sphincter

Buchhave, Per; Flatow, Lennart; Rydhstroem, Håkan; Thorbert, G.

doi:10.1016/s0301-2115(99)00109-8

Cited by 16 publications

(8 citation statements)

References 12 publications

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“…With respect to sphincter injury there are no interventions except caesarean section or routine episiotomy, which are known to have a protective effect, and the effectiveness of episiotomy to prevent OASI has not been conclusively demonstrated. Several authors have demonstrated a protective effect with mediolateral episiotomy, 17,19,22 while others have reported the converse 14,23,24 . Therefore, it would be important to reliably identify high risk women.…”

Section: Discussionmentioning

confidence: 99%

Risk scoring system for prediction of obstetric anal sphincter injury

Williams

Tincello

White

et al. 2005

BJOG

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Objective The objective was to begin the process of developing an antenatal risk scoring system, as a first step towards examining whether elective Caesarean section for women at high risk of injury could be an effective and acceptable intervention. Design Retrospective study.Setting Tertiary maternity unit in the UK.Population One hundred and twenty-three women who sustained an obstetric anal sphincter injury (OASI) and 123 controls without OASI. Methods Case notes of women with a third or fourth degree tear between 1997 and 1999 were examined for risk factors. Controls matched for age and week of delivery were identified from the maternity record database and case records reviewed for the presence of risk factors. Unweighted and weighted risk scores were produced using odds ratios, and compared between cases and controls. Receiver operating characteristics (ROC) curve analysis of the risk scores was performed to discriminate between cases and controls and to calculate the sensitivity and specificity of each scoring system. Main outcome measures Odds ratio (OR) and 95% confidence interval (CI) for each risk factor. Sensitivity and specificity from ROC curves for weighted and unweighted risk score. Results Among the cases there were more nulliparous women (OR 1.77; CI 1.05-2.99) and a trend towards more women with an episiotomy (OR 1.57; CI 0.99 -2.47). Among women with sphincter injury, trends towards more epidurals (OR 1.64; CI 0.97-2.75), and more babies weighing more than 4000 g among (OR 1.45; CI 0.85 -2.49) were noted. The median unweighted risk score was 2 for cases and 2 for controls (P ¼ 0.05), while the weighted risk score was 2.1 and 1.37 (P ¼ 0.03), respectively. The ROC curves approximated to a straight line demonstrating very poor discrimination between cases and controls. Conclusion The predictive test performed poorly, suggesting that the risk factors identified do not exert a large enough effect in a cohort of this size.

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Section: Discussionmentioning

confidence: 99%

Risk scoring system for prediction of obstetric anal sphincter injury

Williams

Tincello

White

et al. 2005

BJOG

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“…Posterolateral episiotomies are usually performed to prevent uncontrolled perineal lacerations at the time of vaginal delivery, 54 but the benefits of this procedure have been questioned, and many authors have claimed that routine use of posterolateral episiotomy may contribute to anal sphincter injury. 7,11,19,20,55,56 As a result, the current trend is toward restricting the use of episiotomy to certain necessary indications, such as malpresentation, shoulder dystocia, persistent occipito-posterior position, fetal distress, or forceps delivery. 57,58 We found no isolated defect of the IAS.…”

Section: Discussionmentioning

confidence: 99%

“…These factors include primiparity, high infant birth weight, macrosomia, prolonged duration of labor, and various procedures including epidural anesthesia, midline episiotomy, and particularly, the use of forceps. [8][9][10][11][12][13][14][15][16] Recent prospective studies have shown that anal sphincter injury is likely to complicate > 60 percent of forceps deliveries (Table 1). 7,[17][18][19][20] Other studies have shown that the risk of anal sphincter injury is lower after vacuum deliveries than after forceps deliveries.…”

mentioning

confidence: 99%

Anal Sphincter Injury After Forceps Delivery: Myth or Reality?

Parades¹,

Etienney²,

Thabut³

et al. 2004

Diseases of the Colon &Amp; Rectum

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Anal sphincter injury after forceps delivery was identified in <13 percent of our large population of healthy females. Our study does not confirm previous observations that anal sphincter injury is common after forceps delivery; previously published studies may have overestimated the prevalence of this condition. The only factor with significant predictive value for anal sphincter injury was perineal tear. Anal endosonography should be recommended after obstetric perineal tear.

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“…Occult or overt injuries to the anal sphincter complex can lead to immediate or delayed incontinence symptoms and the risk may be increased by the practice of obstetric inter-ventions such as fundal pressure, instrumental delivery and episiotomy. [4][5][6] There is great variability in the reported prevalence of obstetric anal sphincter injuries in the literature and this implies that not all obstetric sphincter injuries are identified at the time of the delivery. 7,8 The optimal technique for primary repair of obstetric anal sphincter injury continues to be debated.…”

Section: Introductionmentioning

confidence: 99%

Immediate or delayed repair of obstetric anal sphincter tears—a randomised controlled trial*

Nordenstam

Mellgren

Altman

et al. 2008

BJOG

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Objective To investigate if an 8-to 12-hour time delay of primary repair affects anal incontinence at 1-year follow up.Design Randomised controlled trial.Setting University hospital in Sweden.Population A total of 165 women diagnosed with a third-to fourth-degree perineal tear.Methods The participants were randomised to immediate or delayed (8-to 12-hour delay) end-to-end repair; 78 were allocated to immediate operation and 87 to a delayed repair. An incontinence and pelvic floor symptom questionnaire was completed by the participants at baseline and at 6-and 12-month follow up.Main outcome measures Anal incontinence measured by the validated Pescatori incontinence score.Results A total of 161 (98%) and 155 (94%) women completed the two follow-up questionnaires. There was no significant difference in anal incontinence between the groups. There were no significant differences in pelvic floor symptoms between the groups. A multivariate proportional odds model revealed that increasing maternal age was significantly associated with both increased symptoms of faecal urgency and inability to discriminate flatus from faeces.Conclusion Delayed repair provided the same functional outcome at 1-year follow up. Delaying the repair should thus not be recommended routinely, but can be an alternative under special circumstances when appropriate surgical expertise is not readily available.Keywords Anal incontinence, obstetric anal sphincter tear, primary repair, randomised controlled trial.

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Risk factors for rupture of the anal sphincter

Cited by 16 publications

References 12 publications

Risk scoring system for prediction of obstetric anal sphincter injury

Risk scoring system for prediction of obstetric anal sphincter injury

Anal Sphincter Injury After Forceps Delivery: Myth or Reality?

Immediate or delayed repair of obstetric anal sphincter tears—a randomised controlled trial*

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