title: Rectal tear during normal vaginal delivery with an intact anal sphincter: a case report.
abstract: BACKGROUND
  A rectal tear with an intact anal sphincter is an unusual presentation. Failure to recognize or repair perineal and rectal lesions increases the chance of fistulas and incontinence.
  
  
  METHODS
  A 37-year-old woman, para 1, was admitted with spontaneous onset of labor at 36 weeks following an uncomplicated pregnancy. During the active second stage of labor, spurting of amniotic fluid through the anus was noted. Labor progressed normally, and the patient delivered a healthy infant of 2.5 kg. Immediate per rectal examination revealed a large rectal tear with an undamaged anal sphincter. The defect was repaired, and the patient recovered completely.
  
  
  CONCLUSIONS
  Systematic examination of the perineum, vagina and rectum should be done to assess the severity of damage after all vaginal deliveries in order to recognize occult as well as visible damage. It should be treated promptly to reduce postpartum morbidity.
authors.affiliation: Department of Obstetrics and Gynaecology, City Hospital, Birmingham, UK. tbavananthan@hotmail.com
authors.forename: Bavananthan
authors.initials: B
authors.lastname: Thirumagal
authors.forename: Shagaf
authors.initials: S
authors.lastname: Bakour
mesh_terms: D000328:Adult; D000653:Amniotic Fluid; D001003:Anal Canal; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000473:pathology*; D036801:Parturition; D011247:Pregnancy; D012007:Rectum / Q000293:injuries* / Q000601:surgery