Document Detail

Sphincter rupture and anal incontinence after first vaginal delivery.
MedLine Citation:
PMID:  15453886     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The aim of this prospective study was to establish the incidence of anal incontinence and sphincter defects after first vaginal delivery. METHODS: A total of 99 nulliparous and pregnant women were examined prospectively 4 weeks (mean) before delivery and 4 months (mean) after delivery. Of the study population, 75 (76%) women had vaginal delivery and 24 (24%) had cesarean section. Vacuum extraction was necessary in 20 (20%) cases. The symptoms of anal incontinence were asked about using a standard questionnaire. Clinical examination, endoanal ultrasound (EAUS) and anal manometry were performed before and after delivery. RESULTS: The symptoms of mild anal incontinence, mainly gas incontinence, increased after vaginal delivery more than after cesarean section (P < 0.032). Occult anal sphincter defects were noted in 17 (23%) of the 75 women after vaginal delivery by using EAUS. After vacuum extraction, anal sphincter defects were noted in nine (45%) out of 20 women. No new sphincter defects were found in the cesarean section group. The maximal squeezing pressures were significantly decreased in the patients with external anal sphincter (EAS) defects (P = 0.0025). Vacuum extraction leads to more sphincter defects but does not significantly increase anal incontinence or decrease mean anal sphincter pressures. CONCLUSIONS: The first vaginal delivery can result in occult sphincter defects and the use of vacuum extraction increases the risk.
Tarja M Pinta; Marja-Leena Kylänpää; Kari A W Teramo; Pekka S Luukkonen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Acta obstetricia et gynecologica Scandinavica     Volume:  83     ISSN:  0001-6349     ISO Abbreviation:  Acta Obstet Gynecol Scand     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-09-29     Completed Date:  2004-10-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370343     Medline TA:  Acta Obstet Gynecol Scand     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  917-22     Citation Subset:  IM    
Department of Surgery, Helsinki University Central Hospital, Haartmaninkatu, Helsinki, Finland.
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MeSH Terms
Anal Canal / injuries*,  physiopathology,  ultrasonography
Delivery, Obstetric
Fecal Incontinence / epidemiology*,  etiology
Finland / epidemiology
Medical Records
Obstetric Labor Complications / epidemiology*
Prospective Studies
Retrospective Studies
Vacuum Extraction, Obstetrical
Comment In:
Acta Obstet Gynecol Scand. 2005 Jul;84(7):709; author reply 710   [PMID:  15954887 ]

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