Prospective study of the influence of parity and operative technique on the outcome of primary anal sphincter repair following obstetrical injury.
OBJECTIVE
To determine the influence of parity and method of primary anal sphincter repair on outcome following obstetrical third degree perineal tear.


METHODS
Prospective study of 154 women after primary repair following third degree tear conducted over 2 years. Postpartum evaluation included a continence questionnaire, anal manometry and endoanal ultrasound.


RESULTS
Third degree tears occurred in 1.6% primiparae and 0.6% multiparae during the study period; in 42/112 (38%) primiparae and 10/42 (24%) multiparae, these tears occurred at instrumental deliveries. Mean birthweight (3.8+/-0. 43 kg) was similar in both groups, but prolonged latent second stage of labour (P=0.003), use of epidural analgesia (P<0.0001) and episiotomy extension (P1 quadrant) anal sphincter defect.


CONCLUSIONS
Outcome of anal sphincter repair was not influenced by parity or mode of repair. Despite good symptomatic outcomes, ultrasound evidence of significant anal sphincter injury was found in one-third of patients.
Fitzpatrick
M
M
Department of Obstetrics and Gynaecology, University College Dublin and National Maternity Hospital, Dublin, Ireland.
Fynes
M
M
Cassidy
M
M
Behan
M
M
O'Connell
P R
PR
O'Herlihy
C
C
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D010298:Parity; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography