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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Article info
Publication history
Published online: January 04, 2016
Accepted:
December 10,
2015
Received in revised form:
October 5,
2015
Received:
May 7,
2015
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
