title: Elective cesarean delivery for women with a previous anal sphincter rupture.
abstract: OBJECTIVE
  The purpose of this study was to evaluate elective cesarean delivery for women with a history of anal sphincter rupture.
  
  
  METHODS
  The effectiveness of cesarean delivery in parous women with a previous anal sphincter rupture was determined by decision analysis. The outcomes were excess cesarean deliveries and morbidity and mortality rates per prevented case of anal incontinence.
  
  
  RESULTS
  We needed 2.3 cesarean deliveries to prevent one case of anal incontinence. A woman who chooses a cesarean delivery has a 11.3% risk of morbidity compared with a 4.2% risk for vaginal delivery (relative risk, 2.7; 95% CI, 2.6-2.8; P<.001). The relative risk for maternal death from a cesarean delivery is 2.6 (95% CI, 1.5-4.5; P<.001).
  
  
  CONCLUSIONS
  Continent women with a previous anal sphincter rupture who are delivered vaginally are at high risk for permanent anal incontinence. Cesarean delivery will prevent most cases of anal incontinence, although marginally increasing maternal risk. The increased risk may be justified by the potential benefits. Patients should be counseled on these risks and benefits.
authors.affiliation: Department of Obstetrics and Gynecology, Wright State University, Wright-Patterson AFB, Ohio, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: McKenna
authors.forename: John B
authors.initials: JB
authors.lastname: Ester
authors.forename: John R
authors.initials: JR
authors.lastname: Fischer
mesh_terms: D001003:Anal Canal / Q000293:injuries*; D002585:Cesarean Section / Q000009:adverse effects / Q000401:mortality; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008499:Medical Records; D011247:Pregnancy; D012307:Risk Factors; D012421:Rupture