Obstetric anal sphincter injury and incontinence 15–23 years after vaginal delivery

Halle, Tuva Kristine Toresdatter; Salvesen, Kjell Å.; Volløyhaug, Ingrid

doi:10.1111/aogs.12898

Cited by 39 publications

(34 citation statements)

References 29 publications

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“…1 Hence, levator ani muscle injury is related to the appearance of pelvic organ prolapse 1-3 (affecting mainly the anterior and middle compartments 4,5 ) as well as to fecal incontinence during the postpartum period [6][7][8] and in elderly women. 1 Hence, levator ani muscle injury is related to the appearance of pelvic organ prolapse 1-3 (affecting mainly the anterior and middle compartments 4,5 ) as well as to fecal incontinence during the postpartum period [6][7][8] and in elderly women.…”

Section: Introductionmentioning

confidence: 99%

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

García‐Mejido

Fernández‐Palacín

Barby

et al. 2019

Acta Obstet Gynecol Scand

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Abbreviations: CI, confidence interval; LAM, levator ani muscle; OR, odds ratio. AbstractIntroduction: Forceps delivery is associated with a high rate of levator ani muscle (LAM) trauma (avulsion) at 35%-65% whereas data on avulsion rates after vacuum delivery vary greatly. Nevertheless, a common characteristic of all previous studies carried out to evaluate the association between instrumental deliveries (forceps and vacuum) and LAM avulsion, is the fact that characteristics of the instrumentation have not been described or evaluated. The objective of this study is to compare the rate of LAM avulsion between forceps and vacuum deliveries according to the characteristics of the instrumentation. Material and methods: Prospective, observational study, including 263 nulliparous women, who underwent an instrumental delivery with either Malmström vacuum or Kielland forceps. The characteristics of the instrumentation, position (anterior position and other position) and height of the fetal head at the moment of instrumentation (low instrumentation [vertex at +2 station] and mid-instrumentation [head isinvolved but leading part above +2 station]) were assessed. Evaluation of LAM avulsion was performed at 6 months postpartum by three-/four-dimensional transperineal ultrasound. Using the multi-view mode, a complete avulsion was diagnosed when the abnormal muscle insertion was identified in all three central slices, that is, in the plane of minimal hiatal dimensions and the 2.5-mm and 5.0-mm slices cranial to this one. To detect a 30% or 15% difference in the LAM injury rate, with 80% power and 5% α-error, we needed, respectively 42 and 99 women per study group.Results: In all, 263 nulliparous individuals have been evaluated (162 vacuum deliveries, 101 forceps deliveries). Instrumentation in an occipito-anterior position was more frequent in vacuum deliveries (75.3% vs 56.4%, P = .002), whereas other positions were more frequent in the forceps deliveries group (24.7% vs 43.6%). No statistically significant differences were noted regarding the height of the fetal head at the moment of instrumentation. No statistically significant differences were found in the presence of LAM avulsion (41.4% vs 38.6%) between vacuum and forceps deliveries.The univariate analysis of the crude odds ratio was 1.17, 95% CI 0.67-1.98, P = .70 for

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Section: Introductionmentioning

confidence: 99%

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

García‐Mejido

Fernández‐Palacín

Barby

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%

Anal incontinence after vaginal delivery or cesarean section

Schei

Johannessen

Rydning

et al. 2018

Acta Obstet Gynecol Scand

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“…Worldwide, there has been a significant rise in the incidence of obstetric anal sphincter injury (OASI) over the past two decades. Women with OASI are more likely to be affected by anal incontinence, sexual dysfunction, and impairment of overall quality of life …”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes of the Stop Traumatic OASI Morbidity Project (STOMP)

Basu

Smith

2018

Intl J Gynecology & Obste

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Obstetric anal sphincter injury and incontinence 15–23 years after vaginal delivery

Abstract: OVD was associated with increased risk of OASIS. FD was associated with higher risk of fourth degree perineal tear compared with VD. OASIS was associated with increased risk of anal incontinence and higher CRADI score 15-23 years later.

Cited by 39 publications

References 29 publications

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

Anal incontinence after vaginal delivery or cesarean section

Long‐term outcomes of the Stop Traumatic OASI Morbidity Project (STOMP)

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