Primary Sphincter Repair: Are the Results of the Operation Good Enough?

Pinta, Tarja; Kylänpää, Marja-Leena; Salmi, Tapani; Teramo, Kari; Luukkonen, Pekka

doi:10.1007/s10350-003-0006-9

Cited by 74 publications

(53 citation statements)

References 32 publications

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“…The relatively higher episiotomy rate in our sample (65%) can be explained by the fact that the majority of the patient population (54.4%) was attempting their first vaginal delivery [7,8,23,24]. Our perineal measurements were performed during the second stage of labor immediately before crowning in pregnant women of different parity.…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous posterior perineal lacerations are common during vaginal delivery particularly in nulliparous women causing either occult or recognized anal sphincter disruption with subsequent fecal incontinence in 50% of cases [1][2][3][4][5][6][7][8]. Perineal trauma also contributes to the development of pelvic organ prolapse (POP) and urodynamic stress incontinence as a result of injury to the pelvic floor [1][2][3][4][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…However, the value of this procedure is increasingly questioned because of the associated postoperative morbidity in the absence of clearly defined evidence for efficacy [13][14][15][16][17][18]. Paradoxically, episiotomy, particularly if median, is associated with occurrence of posterior perineal tears involving the anal sphincter in most [1,3,5,[12][13][14][15][16][17][19][20][21][22] but not all [2,[6][7][8]23] studies. Episiotomy also decreases perineal muscle strength and performance during the postpartum period more than does spontaneous posterior perineal laceration because of greater tissue disruption [4,9,16,24].…”

Section: Introductionmentioning

confidence: 99%

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Determinants of the length of episiotomy or spontaneous posterior perineal lacerations during vaginal birth

et al. 2005

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The objective of this study was to measure the length of episiotomy or spontaneous posterior perineal laceration and their relationship to perineal measurements and obstetric variables. The length of the perineum and genital hiatus and vertical length of episiotomy or posterior perineal tears were measured in 114 consecutive parturients with spontaneous singleton term deliveries. Seventy-four (65%) women underwent episiotomy while 40 (35%) sustained spontaneous posterior tears. Perineal or genital hiatus length was significantly correlated to episiotomy (r=0.34, p=0.003) or laceration (r=0.37, p=0.02) length, respectively. This association was significant (p=0.001) in a generalized linear model with duration of second stage of labor (p=0.005), degree of tear (p=0), and parity (p=0). Perineal length was significantly related to maternal age (p=0.036) and weight (p=0.037) and hiatal length (p=0). Short perineum and genital hiatus, long second stage of labor, and low parity are associated with longer posterior perineal injury.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Determinants of the length of episiotomy or spontaneous posterior perineal lacerations during vaginal birth

et al. 2005

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“…A sample size calculation was performed based on the studies that report 40-86% of women have anal sphincter defects after repair of an obstetric anal sphincter laceration [3,[9][10][11][12] and that 37-61% will be symptomatic [3,[10][11][12][13]. The following assumptions were made: (1) 40% of women will have a large anal sphincter defect on endoanal ultrasound and 50% of these women will have anal incontinence symptoms and (2) 60% of women will have small or no anal sphincter defects and 10% of these women will have anal incontinence symptoms.…”

Section: Methodsmentioning

confidence: 99%

“…Risk factors for an obstetric anal sphincter laceration include nulliparity, forceps delivery, episiotomy, macrosomia, prolonged second stage of labor, and occiput posterior position [3,4,[6][7][8]. Even after primary repair of an obstetric anal sphincter laceration, 40-86% of women continue to have anal sphincter defects on endoanal ultrasound [3,[9][10][11][12], and 37-61% will report anal incontinence symptoms after repair of an obstetric anal sphincter laceration [3,[10][11][12][13].…”

Section: Introductionmentioning

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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Effects of a structural simulation curriculum for the repair of obstetrical anal sphincter injuries

Tang

Zhong

Yin

et al. 2022

Intl J Gynecology & Obste

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Objective To assess the short‐term and skill‐retention effects of a structural simulation curriculum for the repair of obstetrical anal sphincter injuries (OASIS). Methods This prepost experimental study recruited 31 obstetrics and gynecology residents from Peking Union Medical College Hospital. OASIS repair skill evaluations (at all timepoints) comprised a task‐specific checklist (TSC), global rating scale (GRS), and pass/fail grade. A beef‐tongue model was adopted in the simulation curriculum. After baseline testing, residents completed a structured 1‐h workshop. Two weeks later, a second test was performed, followed by a one‐to‐one teaching workshop, with the proper completion of a checklist as the end‐point. Three months later, residents completed a third test. Results The overall pass rate at baseline was 16.1%, with higher GRS scores (p = 0.035) in senior residents. Additionally, previewing the procedure before class and a history of OASIS repair observation were associated with higher TSC and GRS scores. Significant skill improvement was observed in the second and third tests, with pass rates of 96.8% and 93.5% respectively. Both TSC and GRS scores were improved compared with baseline (p < 0.001). Conclusion A structural simulation curriculum integrating deliberate practice under supervision improves OASIS repair competence and achieves satisfactory skill retention.

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Primary Sphincter Repair: Are the Results of the Operation Good Enough?

Abstract: After primary sphincter repair, persistent external anal sphincter defect and symptoms of anal incontinence are common in females who have had a primary sphincter repair after vaginal delivery. The means of improving the results of primary repair should be studied further.

Cited by 74 publications

References 32 publications

Determinants of the length of episiotomy or spontaneous posterior perineal lacerations during vaginal birth

Determinants of the length of episiotomy or spontaneous posterior perineal lacerations during vaginal birth

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

Effects of a structural simulation curriculum for the repair of obstetrical anal sphincter injuries

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