Objective: To determine risk factors for obstetric anal sphincter tears and to evaluate symptomatic outcome of primary repair.
Methods: Obstetric-procedure, maternal, and fetal data were registered in 845 consecutive vaginally delivered women. Risk factors for anal sphincter tears were calculated by multiple logistic regression. All 808 Swedish-speaking women who delivered vaginally were included in a questionnaire study regarding anal incontinence in relation to the delivery. Questionnaires were distributed within the first few days postpartum, and at 5 and 9 months postpartum.
Results: Six percent of the women had a clinically detected sphincter tear at delivery. Sphincter tears were associated with nulliparity (odds ratio [OR] 9.8, 95% confidence interval [CI] 3.6, 26.2), postmaturity (OR 2.5, 95% CI 1.0, 6.2), fundal pressure (OR 4.6 95% CI 2.3, 7.9), midline episiotomy (OR 5.5 95% CI 1.4,18.7), and fetal weight in intervals of 250 g (OR 1.3 95% CI 1.1, 1.6). Fifty-four percent of women with repaired sphincter tears suffered from fecal or gas incontinence or both at 5 months and 41% at 9 months. Most of the symptoms were infrequent and mild.
Conclusion: Several risk factors for sphincter tear were identified. Sphincter tear at vaginal delivery is a serious complication, and it is frequently associated with anal incontinence. Special attention should be directed toward risk factors for this complication. Symptoms of anal incontinence should explicitly be sought at follow-up after delivery.
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PLoS Med
January 2025
Université Paris Cité, Center of Research in Epidemiology and StatisticS/CRESS/Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, France.
Background: The French guidelines have recommended a restrictive policy of episiotomy since 2005. We aimed to assess variations in the prevalence of both episiotomy and obstetric anal sphincter injury (OASI) from the 2010, 2016, and 2021 National Perinatal Surveys.
Methods And Findings: A total of 29,750 women who had given birth to a live infant by vaginal delivery were included.
J Gynecol Obstet Hum Reprod
January 2025
Nanomedicine Imaging and Therapeutics Laboratory, INSERM EA 4662, University of Franche-Comte, Besançon, France; CHU de Besançon, Service de Gynécologie-Obstétrique, Besançon, France.
Objectives: This study aimed to describe the biometrics and elasticity of the perineal body and the anal sphincter in the ninth month of pregnancy and explore their association with the risk of perineal tears during childbirth.
Methods: In this prospective observational study, pregnant women at 36-40 weeks of gestation were included. Using transperineal 2D-mode ultrasound and shear wave elastography (SWE), we measured the biometrics and stiffness of the perineal body (PB), external anal sphincter (EAS), internal anal sphincter (IAS), and anal mucosa (AM) at rest and during Valsalva maneuvers.
Inflamm Bowel Dis
January 2025
Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA.
Background: Women with inflammatory bowel disease (IBD) face complexities of disease management during pregnancy and childbirth. Apprehension regarding vaginal delivery in pregnant individuals with IBD persists due to concern for perianal disease and perineal trauma. The incidence of poor wound healing after obstetric anal sphincter injury is approximately 4% in the general population.
View Article and Find Full Text PDFHealthcare (Basel)
December 2024
Department of Translational Medicine, Università del Piemonte Orientale, Gynecology and Obstetrics, "Maggiore della Carità" Hospital, 28100 Novara, Italy.
Background: Obstetric lesions of the anal sphincter (OASIS) are tears intersecting the structure of the anus after vaginal delivery. Our aim is to provide data on the incidence of OASIS and investigate potentially connected risk factors.
Methods: This is a retrospective analysis of 464 parturient patients admitted to the AOU Maggiore della Carità, Novara (Italy), in the last ten years (2013-2023), comparing 116 cases (with OASIS) versus 348 controls (with no OASIS).
JAMA Netw Open
January 2025
Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland.
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