Document Detail

Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery.
MedLine Citation:
PMID:  12699806     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare, in a prospective, randomised controlled trial, differences in anal sphincter function following forceps or vacuum assisted vaginal delivery in an institution practising standardised management of labour. DESIGN: Prospective, randomised controlled trial. SETTING: Tertiary-referral maternity teaching hospital. POPULATION: One hundred and thirty women. METHODS: Primiparous women were recruited antenatally and if an instrumental delivery was indicated, were randomised to either a vacuum or low-cavity, non-rotational forceps assisted delivery. Follow up consisted of a symptom questionnaire, anal manometry and endoanal ultrasound at three months postpartum. MAIN OUTCOME MEASURES: Faecal continence scores, anal manometry, endoanal ultrasound. RESULTS: Sixty-one women delivered with forceps assistance (40 for failure to progress in the second stage) and 69 with vacuum assistance (33 for failure to progress); 16/69 vacuum deliveries proceeded to a forceps assisted delivery (23%). There were no statistical differences in the antecedent antenatal factors between the two groups. A third degree perineal tear followed 10 (16%) forceps and 5 (7%) vacuum deliveries. Based on intention-to-treat analysis, 36 (59%) women complained of altered faecal continence after forceps delivery compared with 23 (33%) following vacuum delivery three months postpartum (RR 2.88, 95% CI 1.41-5.88). Endoanal ultrasound was reported as abnormal following 34 (56%) forceps deliveries and 34 (49%) vacuum deliveries (RR 1.3, 95% CI 0.65-258). After exclusion of 'failed vacuum', median anal canal resting pressure was significantly lower following forceps delivery compared with vacuum delivery alone (P = 0.004). There were no significant differences in degree of ultrasound abnormality between the two groups. CONCLUSIONS: Symptoms of altered faecal continence are significantly more common following forceps assisted vaginal delivery. Based on continence outcome, when circumstances allow, vacuum should be the instrument of first choice in assisted delivery.
Myra Fitzpatrick; Michael Behan; P Ronan O'Connell; Colm O'Herlihy
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  110     ISSN:  1470-0328     ISO Abbreviation:  BJOG     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-17     Completed Date:  2003-06-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  England    
Other Details:
Languages:  eng     Pagination:  424-9     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynaecology, National Maternity and Mater Misericordiae Hospitals, University College Dublin, Ireland.
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MeSH Terms
Anus Diseases / etiology*,  physiopathology,  ultrasonography
Episiotomy / adverse effects
Fecal Incontinence / etiology*,  physiopathology,  ultrasonography
Follow-Up Studies
Obstetric Labor Complications / therapy
Prospective Studies
Puerperal Disorders / etiology*,  physiopathology,  ultrasonography
Vacuum Extraction, Obstetrical / adverse effects*

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