Anal sphincter tears at vaginal delivery: risk factors and clinical outcome of primary repair
Obstetrics and GynecologyPublished 1 July 1999
Jan Zetterström
Citations234
SJR quartileQ1
SJR score1.97
SNIP2.22
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TL;DR
S Sphincter tear at vaginal delivery is a serious complication, and it is frequently associated with anal incontinence, so special attention should be directed toward risk factors for this complication.
Abstract
Several risk factors for sphincter tear were identified. Sphincter tear at vaginal delivery is a serious complication, and it is frequently associated with anal incontinence. Special attention should be directed toward risk factors for this complication. Symptoms of anal incontinence should explicitly be sought at follow-up after delivery.
Keywords
Medicine
The LancetINJURY TO INNERVATION OF PELVIC FLOOR SPHINCTER MUSCULATURE IN CHILDBIRTH
851 Citations1984S. J. Snooks, Michael Swash +2 more
The results of the study suggest that in most cases this incontinence results from damage to the innervation of the pelvic floor muscles.
BMJThird degree obstetric anal sphincter tears: risk factors and outcome of primary repair
766 Citations1994Abdul H. Sultan, Michael A. Kamm +2 more
Vacuum, extraction is associated with fewer third degree tears than forceps delivery and an episiotomy does not always prevent a third degree tear, according to retrospective analysis of obstetric variables.
Obstetrical & Gynecological SurveyBenefits and Risks of Episiotomy
436 Citations1983STEPHEN B. THACKER, H. DAVID BANTA
There is evidence that postpartum pain and discomfort are accentuated after episiotomy, and serious complications, including maternal death, can be associated with the procedure, so carefully designed controlled trials of benefit and risk should be carried out on the use of Episiotomy.
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217 Citations1993Abdul H. Sultan, Michael A. Kamm +2 more
Compared with vacuum extraction, forceps delivery is associated with significantly more damage to the anal sphincters and hence an increased incidence of defecatory symptoms, and PNTML was not significantly altered by the mode of delivery.
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207 Citations1996Tine Tetzschner, Michael Sørensen +2 more
The long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence and to identify factors to predict women at risk are assessed.
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197 Citations1990C. Andrew Combs, Patricia A. Robertson +1 more
Factors associated with increased risk for third- and fourth-degree lacerations were midline episiotomy, nulliparity, second-stage arrest, occipitoposterior position, low or mid station, use of forceps instead of vacuum,Use of local anesthesia, and Asian race.
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Scarring was less noticeable after the midline incision and intercourse began earlier, and anal sphincter injury was significantly more common after a midline procedure but no rectovaginal fistulae occurred.
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Primiparity, instrumental deliveries, abnormal presentation, large babies and oxytocin stimulation were all risk factors for anal sphincter ruptures, and long-term symptoms occurred in 7 (88%) of women with ASR also involving the anal mucosa, but only in 21 (39%) of those with AsR only.
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Risk factors for third degree obstetric perineal tears are determined and recommendations for prevention are given.
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144 Citations1993LISA A. CRAWFORD, ELISABETH H. QUINT +2 more
Incontinence of flatus was reported six times more often by women who experienced a third‐ or fourth‐degree perineal laceration than by those without anal sphincter rupture.
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120 Citations1989Green, Soohoo Sl
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The high incidence of fecal incontinence by 6 months postpartum in all women is surprising and deserves further investigation, specifically regarding occult sphincter rupture.
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100 Citations1993Michael Sørensen, Tine Tetzschner +3 more
Continence disturbances are frequent after sphincter rupture; these patients should be monitored after delivery and those with persisting incontinence offered spHincter repair.
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92 Citations1990Knut Haadem, Jan Anders Dahlström +1 more
A significantly increased frequency of gas incontinence was found in the women with anal sphincter rupture, however, a significantly increased number of patients after 12 months.
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85 Citations1997Michael Klein, Patricia A. Janssen +3 more
Determinants of sulcus tears appear to be present before pregnancy; third- and fourth-degree tears are related to physician management and exercise mitigates the potential for severe trauma induced by episiotomy.
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Median episiotomy is strongly associated with third- and fourth-degree perineal lacerations in primiparous women, and reducing the use of this procedure could decrease the occurrence of severePerineal tears.
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51 Citations1988Legino Lj, Woods Mp +2 more
Since midline episiotomies are now being performed often, third- and fourth-degree perineal tears will continue to be common and will depend on the patient population, physician experience and intrapartum hospital policies.
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46 Citations1996Karen R. Cosner
In the group of women who were delivered with use of fundal pressure, second-stage labor was longer and a higher incidence of third- and fourth-degree perineal lacerations was observed compared with those women who delivered spontaneously.
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36 Citations1994Britta Gareberg, Brltt Magnusson +4 more
A major change in the use of delivery position has occurred in Sweden and the consequences of this shift in obstetrical practice for development of perineal lacerations are largely unknown.
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24 Citations1993P R Mendes da Costa, Ph Lurquin
American Journal of PerinatologyVaginal Delivery is Associated with Occult Disruption of the Anal Sphincter Mechanism
21 Citations1997David A. Sandridge, John Thorp +3 more
Endovaginal sonography allows thorough assessment of the anorectum and in this study was used to assess nulliparous women and women before and after delivery, finding vaginal delivery is associated with occult disruption of the anal sphincters and birth is thought to be an important cause of pelvic floor dysfunction.
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It was concluded that estrogens have no effects on manometric parameters of the external sphincter and that anal manometry may not be the appropriate method to assess the effects of estrogens on the pelvic floor.