Obstetric anal sphincter injury: a follow-up questionnaire study on longer-term outcomes

Cornelisse, Simone; Arendsen, Linda; Kuijk, Sander M. J. van; Kluivers, Kirsten B.; Dillen, Jeroen van; Weemhoff, Mirjam

doi:10.1007/s00192-016-3017-5

Cited by 28 publications

(25 citation statements)

References 22 publications

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“…Cesarean delivery is related to respiratory neonatal morbidity and there is an increasing focus on a possible association between cesarean delivery and long‐term immunologic morbidity . On the other hand, planned vaginal delivery imposes a risk of OASISwith the reported incidence of anal incontinence wide‐ranging from 7% to 61% …”

Section: Discussionmentioning

confidence: 99%

Maternal short‐term complications after planned cesarean delivery without medical indication: A registry‐based study

Otkjær

Jørgensen

Clausen

et al. 2019

Acta Obstet Gynecol Scand

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| INTRODUC TI ONTechnology constantly challenges our perception of best practice regarding healthcare. During the mid-1990s and early 2000s the rates of cesarean section in Denmark rose rapidly, from 12.8% in 1996 to 20.8% in 2006, 1 only to stabilize around 20% since then. 1 As a result of this development, several hospitals are currently trying to reduce the rate of cesarean deliveries in Denmark, 2,3 this with reference to higher rates of maternal complications associated with cesarean delivery when compared with vaginal delivery. 4-6 Nonetheless, the validity of this statement has been questioned and discussed in the media on several occasions when it comes to one specific group: Abbreviations: BMI, body mass index; CDMR, cesarean delivery on maternal request; DMBR, the Danish Medical Birth Registry; ECD, emergency cesarean delivery; OASIS, obstetric anal sphincter ruptures; PCD, planned cesarean delivery; PVD, planned vaginal delivery. Abstract Introduction: The aim of this study was to compare short-term maternal outcomes in healthy primiparous women with uncomplicated pregnancies who delivered a singleton child at term by planned cesarean or planned vaginal delivery. Material and methods: Nationwide population-based cohort study of 145 821 low-risk primiparous women with healthy singletons in cephalic position in Denmark, 2008-2016. Data from the Medical Birth Register and the Danish National Patient Registry were linked and compared according to planned mode of delivery. Main outcome measures were major morbidity including maternal death, cardiac arrest, hysterectomy and thromboembolic disease. Minor maternal morbidity includes wound infection, postpartum fever, wound rupture and reoperation, bladder lesions, spinal headache and Ogilvie syndrome. Additionally, anal sphincter injuries were registered. Results: The study included 141 782 planned vaginal deliveries and 4039 planned cesarean deliveries. Severe maternal complications occurred in fewer than 1/4000 in both categories. Women with planned cesarean had a slightly higher risk of wound infections (0.17% vs 0.07%; P = 0.04). There were no significant differences in the remaining minor and major outcomes. Women with planned vaginal delivery had a 4.97% risk of obstetric anal sphincter injuries. Conclusions: For healthy primiparous women, both planned vaginal delivery and planned cesarean delivery are highly safe procedures when the short-term maternal outcome is taken into account. Planned cesarean delivery is associated with a slightly increased risk of wound infection compared with planned vaginal delivery. Women with planned vaginal delivery had a 4.97% risk of obstetric anal sphincter injuries. K E Y W O R D S cesarean delivery on maternal request, healthy primiparous women, maternal outcomes, planned cesarean section, planned vaginal delivery, short-term maternal complications

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Section: Discussionmentioning

confidence: 99%

Maternal short‐term complications after planned cesarean delivery without medical indication: A registry‐based study

Otkjær

Jørgensen

Clausen

et al. 2019

Acta Obstet Gynecol Scand

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“…Fecal urgency is defined as having difficulty deferring a sudden or compelling desire to defecate. 5,14,[16][17][18][19][20] The role of planned CS in order to prevent OASIS, AI, and the potential impact of delivery on women's future health remains unclear 1,7,21 A Cochrane Review concluded that planned CS showed no benefit in the prevention of AI in postpartum women. 2,12,13 Furthermore, other studies have shown that AI, in particular, may have a devastating impact on women's social, emotional, and physical activity as well as their quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…14,15 AI is associated with increasing age, obesity, pregnancy, instrumental VD, and obstetric anal sphincter injury (OASIS). 5,14,[16][17][18][19][20] The role of planned CS in order to prevent OASIS, AI, and the potential impact of delivery on women's future health remains unclear 1,7,21 A Cochrane Review concluded that planned CS showed no benefit in the prevention of AI in postpartum women. 7 The aim of this study was to explore whether women who only had delivered vaginally were at greater risk of developing AI than women who had undergone only cesarean sections or women who had never experienced childbirth.…”

Section: Introductionmentioning

confidence: 99%

Anal incontinence after vaginal delivery or cesarean section

Schei

Johannessen

Rydning

et al. 2018

Acta Obstet Gynecol Scand

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“…A study by Cornelisse et al in the Netherlands found that 39% of women with OASIS suffered from anal incontinence four years postpartum, as compared to 20% of women who delivered vaginally without OASIS (19). Cornelisse et al found that most of the women suffered from leakage of atus, 31% of the women with OASIS and 18% of the women without OASIS experienced this.…”

Section: Andrews Et Al Found That 14% Of Women Who Deliver Vaginally mentioning

confidence: 99%

Anal incontinence and unrecognized anal sphincter injuries after vaginal delivery - A cross-sectional study in Norway

Berg

Sahlin

2020

Preprint

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Background: Aim of the study was to estimate the prevalence of postpartum anal incontinence among women who delivered vaginally, and to assess the extent to which obstetric injuries to the anal sphincters are missed.Methods: All women (both primiparous and multiparous) who delivered vaginally and received any kind of sutures in the perineal area at Innlandet Hospital Trust Elverum in Norway between January 1, 2015 and June 30, 2016 were invited to answer a questionnaire on St. Mark’s incontinence score and to participate in a clinical examination of the pelvic floor including endoanal sonography. Results: In total 52,3% (n=207) of the 396 invited women participated in the study. Mean St. Mark’s score was 1.8 points (95% CI 1.4 to 2.1) at examination 14 months (mean) postpartum, and none of the participants suffered from weekly fecal leakage. Fecal urgency affected 11.7% (95% CI 7.1 to 16.3) of the participants, and 8.7% (95%CI 5.1 to 12.8) had weekly involuntary leakage of flatus. Nine women (9.3%, 95% CI 4.1 to 15.5) had a previously undetected third degree obstetric anal sphincter injury. Conclusion: The prevalence of anal incontinence among women who have delivered vaginally and received sutures due to 1st and 2nd degree perineal lacerations is low. Some obstetric anal sphincter injuries remain unrecognized at the time of delivery, but the symptoms of anal incontinence due to these injuries are in the lower half of the St. Mark’s incontinence score. Women with persistent symptoms like fecal urgency or leakage of gas and/or feces should be referred to evaluation by a colorectal surgeon in order to achieve optimal treatment.

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Obstetric anal sphincter injury: a follow-up questionnaire study on longer-term outcomes

Abstract: In this study, women with OASIS had a more than doubled risk of longer-term bothersome symptoms of AI compared with controls. Symptoms were experienced as bothersome and as having an influence on QoL.

Cited by 28 publications

References 22 publications

Maternal short‐term complications after planned cesarean delivery without medical indication: A registry‐based study

Maternal short‐term complications after planned cesarean delivery without medical indication: A registry‐based study

Anal incontinence after vaginal delivery or cesarean section

Anal incontinence and unrecognized anal sphincter injuries after vaginal delivery - A cross-sectional study in Norway

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