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Does anal sphincter injury preclude subsequent vaginal delivery?

Published:January 04, 2016DOI:https://doi.org/10.1016/j.ejogrb.2015.12.004

      Abstract

      Objective

      To assess continence and anal sphincter integrity during a subsequent pregnancy and delivery in women known to have a previous anal sphincter injury.

      Design

      Prospective observational study.

      Setting

      The National Maternity Hospital, Dublin, Ireland.

      Population

      Antenatal patients with a documented obstetric anal sphincter injury at a previous delivery.

      Methods

      Women underwent symptom scoring, endoanal ultrasound and manometry.

      Main outcome measures

      Recommended and actual mode of delivery, continence scores and endoanal ultrasound findings after index delivery.

      Results

      557 women were studied. 293 (53%) had no symptoms of faecal incontinence, 189 (34%) had mild symptoms and 75 (13%) moderate or severe symptoms.
      408 (73%) had an endoanal ultrasound. 383(94%) had a normal or small (<1 quadrant) defect in the internal anal sphincter and 390 (96%) had a scar or small (<1e quadrant) defect in the external anal sphincter.
      393 (70%) delivered vaginally. 164 (30%) were delivered by caesarean section. 197/557 (35%) returned for follow-up. There was no significant change in continence following either vaginal or caesarean delivery. 20 (5.1%) women had a recognised second anal sphincter tear during vaginal delivery.

      Conclusions

      The majority of women who sustain a third degree tear have minimal or no symptoms of faecal incontinence when assessed antenatally in a subsequent pregnancy. 70% go on to have a vaginal delivery, with little impact on faecal continence. These findings provide reassurance for patients and clinicians about the safety of vaginal delivery following anal sphincter injury in appropriately selected patients.

      Keywords

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