Risk of Recurrence of Anal Sphincter Lacerations

Abstract

III.

Is severe perineal damage increased in women with prior anal sphincter injury?

“…We reported no significant increase in the risk of recurrent lacerations using data from the Pennsylvania State in-patient database, while Spydslaug et al from Norway have reported an increase in the risk [7,8]. The limitation of both these studies was the use of state or national administrative databases as the source of data, which is subject to reporting bias and/or collection bias.…”

“…In our earlier study of women with prior lacerations in the state of Pennsylvania, we did not find an increase in the rate of recurrent laceration [7]. Both of these studies were based on the analysis of large databases and therefore were subject to reporting bias and dependent on the diligence with which information was collected at the various hospitals.…”

Recurrence of Obstetric Third-Degree and Fourth-Degree Anal Sphincter Injuries

“…The risk of recurrent obstetric anal sphincter injuries was doubled in those who delivered a large-forgestational-age neonate and in those who had an instrumental delivery. 5,10 Outcomes after primary obstetric anal sphincter injuries that are recognized and repaired are favorable with 60-85% of women being asymptomatic at 6-12 months follow-up. Those involving the anal sphincter complex (third-degree lacerations), the anal mucosa (fourthdegree lacerations), or both are termed obstetric anal sphincter injuries.…”

“…The incidence of obstetric anal sphincter injuries after vaginal delivery is reported widely ranging from 0.5-11%. 5,10,11,[15][16][17] This paucity of evidence has resulted in a near absence of guidelines from professional bodies. The highest probability of occurrence is related to instrumental delivery, particularly forceps, in the primiparous delivering a neonate in excess of 4 kg in the occiputposterior position.…”

Anal incontinence

“…Dandolu and colleagues reported a large study of 258,507 vaginal deliveries from Pennsylvania in which they analysed the risk of a subsequent tear after an initial sphincter injury [27]. The rate of sphincter tear was 7.31%.…”