Anal sphincter injury after vaginal delivery in primiparous females

Belmonte-Montes, Carlos; Hagerman, Gonzalo; Vega-Yepez, Paul Alan; Hernández-de-Anda, Enrique; Fonseca-Morales, J.V.

doi:10.1007/bf02234778

Cited by 52 publications

(36 citation statements)

References 28 publications

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“…In fact, these complications pose significant costs to the health care system [17] . Considering that endoanal ultrasound reveals poor results of primary AST repair [2,16] , the importance of avoiding ASTs during vaginal delivery is even more imminent.…”

Section: Introductionmentioning

confidence: 99%

Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study

Haslinger

Burkhardt

Stoiber

et al. 2014

Journal of Perinatal Medicine

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Objective:This work aimed to analyze the association between maternal position at birth in spontaneous deliveries and the occurrence of anal sphincter tears (AST) given the lack of evidence related to the least traumatic birth position. Study design: A total of 7832 vaginal deliveries were included. Vaginal-operative deliveries and deliveries with fundal pressure were excluded. Birth positions on bed, in water, kneeling, and in a squatting position on a low stool were compared. Birth position on bed was considered as the reference group, and a logistic regression analysis adjusting for important fetomaternal parameters was performed. Results: The overall incidence of AST was 1.1%. AST rate was significantly increased in squatting (2.9%) and kneeling (2.1%) positions compared with birth position on bed (1.0%) or in water (0.9%). Logistic regression analysis revealed a significantly higher risk for ASTs in squatting (OR 2.92, CI 95% 1.04-8.18) and in kneeling positions (OR 2.14, CI 95% 1.05-4.37) compared with the reference group on bed. When adjusting for risk factors, birth in a kneeling position remained significantly associated with ASTs (adj. OR 2.21, CI 95% 1.07-4.54). Conclusions: Birth in squatting or in kneeling position is associated with an elevated risk for ASTs. Birth in water is not associated with an increased risk for AST. Based on the results, women should be informed about the association of certain birth positions with the occurrence of AST. given the lack of evidence related to the least traumatic birth position. Study design : A total of 7832 vaginal deliveries were included. Vaginal-operative deliveries and deliveries with fundal pressure were excluded. Birth positions on bed, in water, kneeling, and in a squatting position on a low stool were compared. Birth position on bed was considered as the reference group, and a logistic regression analysis adjusting for important fetomaternal parameters was performed. Results : The overall incidence of AST was 1.1%. AST rate was significantly increased in squatting (2.9%) and kneeling (2.1%) positions compared with birth position on bed (1.0%) or in water (0.9%). Logistic regression analysis revealed a significantly higher risk for ASTs in squatting (OR 2.92, CI 95% 1. 04 -8.18) and in kneeling positions (OR 2.14, CI 95% 1.05 -4.37) compared with the reference group on bed. When adjusting for risk factors, birth in a kneeling position remained significantly associated with ASTs (adj. OR 2.21, CI 95% 1.07 -4.54). Conclusions : Birth in squatting or in kneeling position is associated with an elevated risk for ASTs. Birth in water is not associated with an increased risk for AST. Based on the results, women should be informed about the association of certain birth positions with the occurrence of AST.

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Section: Introductionmentioning

confidence: 99%

Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study

Haslinger

Burkhardt

Stoiber

et al. 2014

Journal of Perinatal Medicine

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“…Current diagnostic imaging tools available for evaluation of the anal sphincter complex (ASC) include pelvic floor fluoroscopy, defecography, computed tomography (CT), magnetic resonance imaging (MRI), and diagnostic ultrasound (endoanal, endovaginal, and translabial). Many of these modalities are either not widely accessible or require specialized equipment, are invasive, and may be poorly tolerated by patients [1][2][3][4][5][6][7][8]. The current gold standard for the evaluation of anal sphincter anatomy is considered to be endoanal sonography.…”

Section: Introductionmentioning

confidence: 99%

“…The equipment needed to perform TLU is readily available to all gynecology and radiology imaging laboratories. Aside from the actual modality utilized, MRI, TLU, and endoanal studies of the anal sphincter complex are quite varied in terms of reporting measurements both with regard to which levels of the ASC were measured and how specific anatomic structures were described [5,14].…”

Section: Introductionmentioning

confidence: 99%

Translabial ultrasound assessment of the anal sphincter complex: normal measurements of the internal and external anal sphincters at the proximal, mid-, and distal levels

et al. 2007

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The purpose of this study was to measure the internal and external anal sphincters using translabial ultrasound (TLU) at the proximal, mid, and distal levels of the anal sphincter complex. The human review committee approval was obtained and all women gave written informed consent. Sixty women presenting for gynecologic ultrasound for symptoms other than pelvic organ prolapse or urinary or anal incontinence underwent TLU. Thirty-six (60%) were asymptomatic and intact, 13 symptomatic and intact, and 11 disrupted. Anterior-posterior diameters of the internal anal sphincter at all levels and the external anal sphincter at the distal level were measured in four quadrants. Mean sphincter measurements are given for symptomatic and asymptomatic intact women and are comparable to previously reported endoanal MRI and ultrasound measurements.

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“…Many subsequent studies have explored occult sphincter defects and their relationship to symptoms of AI. The prevalence of occult sphincter defects has been estimated between 12 and 35% after vaginal delivery [22,[26][27][28][29][30]. In spite of some evidence to the contrary [28], the majority of evidence points to a significant association between symptoms and the presence of a defect [16,27,31,32].…”

Section: Anal Sphincter Defectsmentioning

confidence: 99%

Fecal incontinence: a review of prevalence and obstetric risk factors

et al. 2005

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Anal incontinence (AI) is a significant problem that causes social and hygienic inconvenience. The true prevalence of AI is difficult to estimate due to inconsistencies in research methods, but larger studies suggest a rate of 2-6% for incontinence to stool. There is a significant association between sonographically detected anal sphincter defects and symptoms of AI. The intrapartum factors most consistently associated with a higher risk of AI include: forceps delivery, third or fourth degree tears, and length of the second stage of labor. Fetal weight of > 4,000 g is also associated with AI. Repair of the sphincter can be performed in either an overlapping or an end-to-end fashion, with similar results for both methods. The role of cesarean delivery for the prevention of AI remains unclear, and further study should be devoted to this question.

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Anal sphincter injury after vaginal delivery in primiparous females

Cited by 52 publications

References 28 publications

Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study

Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study

Translabial ultrasound assessment of the anal sphincter complex: normal measurements of the internal and external anal sphincters at the proximal, mid-, and distal levels

Fecal incontinence: a review of prevalence and obstetric risk factors

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