A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears

Fitzpatrick, Myra; Behan, Michael; O’Connell, P. Ronan; O’Herlihy, Colm

doi:10.1067/mob.2000.108880

Cited by 178 publications

(87 citation statements)

References 11 publications

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“…However, the key issue is to limit the number of cesarean deliveries performed to prevent one obstetric anal sphincter laceration. In addition, research could focus on lowering the rates of anal sphincter defects and anal incontinence symptoms by improving the repair techniques, possibly by using an overlapping anal sphincter repair [15,19,19], using an operating-room-type setting for better exposure or using polydioxanone suture to avoid early wound breakdown [19]. Current evidence has not yet clearly answered these questions [15,16,19].…”

Section: Discussionmentioning

confidence: 99%

Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women

Vaccaro

Clemons

2008

Int Urogynecol J

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A study was carried out to identify (1) incidence of anal incontinence symptoms, (2) incidence and size of both external anal sphincter (EAS) and internal anal sphincter (IAS) defects, and (3) relationship between anal incontinence symptoms and IAS or EAS defect size after repair of an obstetric anal sphincter laceration. Forty-seven vaginally primiparous women underwent obstetric anal sphincter laceration repair. At 8-12 weeks postpartum, anal incontinence symptoms were assessed, and endoanal ultrasound was performed. At 1-2 years postpartum, symptoms were reassesseds. The incidence of anal incontinence symptoms at 8-12 weeks was 43%. The incidence of IAS and EAS defects were 32% and 77%, respectively. IAS defects > or = 45 degrees were predictive of symptoms (p = 0.02). After 18 months mean follow-up, 11% reported chronic symptoms. After anal sphincter laceration repair, anal incontinence symptoms occur in 43% of women and remain chronic in 11%. Anal incontinence symptoms are associated with increasing IAS defect size.

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Section: Discussionmentioning

confidence: 99%

Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women

Vaccaro

Clemons

2008

Int Urogynecol J

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“…Fetal outcome was similar; five infants from the immediate pushing group and six from the delayed pushing group required admission to the neonatal unit; one infant from the immediate pushing group suffered neonatal seizures. Nine (10%) women in the immediate and six (7%) in the delayed pushing groups sustained recognised third degree perineal tears, which were repaired as described by Fitzpatrick et al 22 . Overall, 23 (26%) women in the immediate pushing group and 33 (38%) in the delayed pushing group experienced alteration of faecal continence postpartum.…”

Section: Resultsmentioning

confidence: 99%

A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal continence

Fitzpatrick

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To assess the effects of delayed vs immediate pushing in second stage of labour with epidural analgesia on delivery outcome, postpartum faecal continence and postpartum anal sphincter and pudendal nerve function. Design Prospective, randomised, controlled trial.Setting Tertiary referral maternity teaching hospital.Population One hundred and seventy nulliparous women randomised at full dilatation to immediate or delayed pushing. Methods A total of 178 nulliparous women, all with continuous epidural analgesia, were randomised at full cervical dilatation, but before the fetal head had reached the pelvic floor, to either immediate pushing or 1 hour delayed pushing. Labour outcome was analysed and all women underwent postpartum assessment of anal sphincter function, including anal manometry. Those women who had a normal delivery underwent neurophysiology studies, while those women who had an instrumental delivery underwent endoanal ultrasound. Main outcome measures Mode of delivery; altered faecal continence.Results Ninety women were randomised to immediate pushing and 88 to delayed pushing. The spontaneous delivery rate was 56% (50/90) in the immediate pushing group and 52% (46/88) in the delayed pushing group. Mean duration of labour for the immediate pushing group was 427 minutes compared with 480 minutes for the delayed pushing group ( P ¼ 0.005). Eighty-four percent (76/90) of women in the immediate pushing group received oxytocin to augment labour, 21/76 (28%) in the second stage only. Eighty-one percent (71/88) of women in the delayed pushing group received oxytocin to augment labour, 22/71 (31%) in the second stage only. Fetal outcome did not differ between the two groups. Episiotomy rates were 73% and 69% in the immediate pushing and delayed pushing groups, respectively. 26% (23/90) of the immediate pushing group and 38% (33/88) of the delayed pushing group complained of altered faecal continence after delivery (NS). Manometry, ultrasound and neurophysiology studies did not differ significantly between the two groups. Overall, 55% of women after instrumental delivery had endosonographic evidence of damage to the external anal sphincter, while 36% of women after spontaneous delivery had abnormal neurophysiology studies. Conclusions Rates of instrumental delivery were similar following immediate and delayed pushing, in association with epidural analgesia. Delayed pushing prolonged labour by 1 hour but did not result in significantly higher rates of altered continence or anal sphincter injury, when compared with immediate pushing.

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“…Even when anal sphincter damage is recognised at delivery, current methods of surgical repair are inadequate. Persistent anal sphincter defects are present in up to 85% of women who sustain anal sphincter laceration and repair at the time of vaginal delivery (14,15). Especially because surgical repair cannot restore normal anatomy and function, it is critically important to prevent the initial damage at vaginal delivery.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing The Use Of Episiotomy During Vaginal Delivery In South Eastern Nigeria

Chigbu¹,

Onwere²,

Aluka³

et al. 2008

E Af Med Jrnl

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Background: Given considerable evidence that routine episiotomy increases maternal morbidity and without evidence to support maternal or neonatal benefit, has episiotomy use changed among health care providers? To date, very limited information exists relating to the past and current practice of episiotomy in many developing countries. Results: There were 1877 episiotomies, for an episiotomy rate of 45%. Ninety per cent of the primigravid parturients had episiotomy. Women undergoing episiotomy were younger (mean age 24.7 years; range 16-37) than women without episiotomy (mean age 28.5 years, range 20-43). When controlled for parity and maternal age, other risk factors were occipito-posterior position, vacuum extraction, forceps delivery, vaginal breech delivery, and a history of Caesarean section. Episiotomy use was also associated with major perineal lacerations and increased length of hospital stay. Conclusion: The episiotomy rate of 45 per 100 vaginal deliveries in this study is obviously higher than evidence-based recommendations for optimal patient care. A policy of systematic reduction in the incidence of episiotomy can be pursued in this hospital. Greater attention needs to be paid to selection of women to undergo episiotomy.

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A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears

Cited by 178 publications

References 11 publications

Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women

Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women

A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal continence

Factors Influencing The Use Of Episiotomy During Vaginal Delivery In South Eastern Nigeria

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