[Fecal incontinence, occult lesions to the anal sphincter and related factors in primiparous patients without median routine episiotomy].
BACKGROUND
Fecal incontinence is more frequent among women, mainly because of obstetrical trauma. The factors that induce these lesions have been widely studied. The Mexican Official Medical Regulations cancelled the routine use of episiotomy during vaginal delivery, taking into account many of these studies. We undertook this study to determine the frequency of anal sphincter lesions and fecal incontinence in primiparous women without episiotomy and related these lesions to maternal, obstetrical and newborn factors that could predispose to the origin of these lesions.


METHODS
Primiparous women attended between May 2002 and May 2004, of any age, healthy, with uncomplicated term pregnancies were included. Before labor, a clinical examination, incontinence questionnaire and anal ultrasound were performed and the procedure was repeated 6 weeks after labor. Maternal, delivery and newborn factors were evaluated and compared in cases with fecal incontinence or anal sphincter lesions. Chi square test was utilized for categorical variables.


RESULTS
We studied a total 122 patients, 62 were excluded (22 required Cesarean section and 40 failed to attend follow-up). Of these, postpartum incontinence was reported in 14 (23%) (minor in 13, 22%) and major in 1, 1.6%), sphincter lesion in 7 (12%), occult lesion in 3 (5%); incontinence without sphincter lesion in 10 (71%), and adverted partum canal lesion in 45 (75%).


CONCLUSIONS
We found a high incidence of anal sphincter lesions in primiparous women without routine episiotomy but a reduced incidence of severe lesions and major fecal incontinence. There is a probable relation of lesions with newborn birthweight and height, duration of 2nd partum period, adverted lesion and attending physician (not statistically demonstrated).
Belmonte-Montes
Carlos
C
Departamento de Cirugía, Universidad del Ejército y Fuerza Aérea, Hospital Central Militar, México. bmcarlos@prodigy.net.mx
Cervera-Servín
J Andrés
JA
García-Vázquez
José Luis
JL
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries*; D001724:Birth Weight; D001827:Body Height; D001835:Body Weight; D002508:Cephalometry; D002584:Cervix Uteri / Q000293:injuries; D004841:Episiotomy; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007747:Labor Stage, First; D007748:Labor Stage, Second; D008800:Mexico; D007744:Obstetric Labor Complications / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology / Q000209:etiology*; D047929:Term Birth; D013997:Time Factors; D014463:Ultrasonography