title: [Anal sphincter tears after vaginal delivery: risks factors and means of prevention].
abstract: To identify incidence and risks factors of obstetrical anal sphincter lacerations, we reviewed all cases of 3rd and 4th degree sphincter lacerations after vaginal deliveries (VD) occured in a tertiary maternity between 2005 and 2010. 78 anal sphincter lacerations were identified (3.8/1000 deliveries). 66 women (85%) were nulliparous. The mean age of women was of 29 +/- 5 years. The mean duration of the second stage of labour was of 3.4 +/- 1,7 hour. The birth weight of 12 newborns (15%) was greater than 4000 grams. Fourty-six women (2.5%) had sphincter lacerations after instrumental delivery and 32 after spontaneous vaginal delivery (0.2%). 51 patients out of 78 (65%) had a medio-lateral episiotomy, 82% occured after instrumental extraction and 43% after spontaneous delivery. A forceps of Tarnier was used in 18 cases, a Suzor forceps in 12 cases, spatula in 12 cases and vacuum in 4 cases. 76% of foetuses were in anterior presentation and 78% at the medium part of the pelvis. 2 patients experienced anal incontinence in early post-partum. Anal sphincter lacerations are relatively frequent after VD especially after instrumental delivery. Macrosomia, nulliparous women, prolonged second stage of labor were associated with anal sphincter tears. Medio-lateral episiotomy does not protect enough anal sphincters. Anal sphincter lacerations lead to anal incontinence in some cases.A long follow-up is useful for these patients.
authors.affiliation: Département de Gynécologie-Obstétrique, Centre Hospitalier Regional d'Orleans, 1 Porte Madeleine, 45000, France. souhail.alouini.@chro-orleans.fr
authors.forename: S
authors.initials: S
authors.lastname: Alouini
authors.forename: L
authors.initials: L
authors.lastname: Rossard
authors.forename: B
authors.initials: B
authors.lastname: Lemaire
authors.forename: P
authors.initials: P
authors.lastname: Mégier
authors.forename: L
authors.initials: L
authors.lastname: Mesnard
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D001724:Birth Weight; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D022125:Lacerations; D011247:Pregnancy; D012189:Retrospective Studies