title: [Management of third and fourth degree perineal tears: A systematic review].
abstract: This was a comprehensive literature review using Pubmed, Medline, Embase and Cochrane, whose aim was to analyse the prevalence of anal sphincter injuries, their risk factors, their management and their functional prognosis. The prevalence of 3rd and 4th degree perineal tears varies between studies from 2.95% regardless the parity to 25% in nulliparous women. Twenty-eight percent to 48% of these lacerations were clinically occult. Perineal tears were associated with (multivariate analysis) forceps (6.021 [IC 95% 1.23-19.45]), nulliparity (OR 9.8 [IC 95% 3.6-26.2]), gestational age over 42 SA (OR 2.5 [IC 95% 1-6.2]), fundal pressure (OR 4.6 [IC 95% 2.3-7.9]), midline episiotomy (OR 5.5 [IC 95% 1.4-18.7]) or fetal weight in interval of 250g (OR 1.3 [IC 95% 1.1-1.6]). There was no difference between the sphincter repair techniques. Post-partum laxative use showed less painful bowel motion and earlier postnatal discharge. Data concerning rehabilitation were contradictory. The rate of anal incontinence 6 months after vaginal delivery were 3.6% following third degree of perineal tear and 30.8% in case of fourth degree of perineal tear. Thirty years after anal sphincter disruption, the prevalence of fecal incontinence reached 6.9%.
authors.affiliation: Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN (Group of clinical research in neuro-urology, university Pierre and Marie Curie), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Villot
authors.affiliation: Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN (Group of clinical research in neuro-urology, university Pierre and Marie Curie), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.affiliation: Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
authors.forename: G
authors.initials: G
authors.lastname: Demoulin
authors.affiliation: Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Rivain
authors.affiliation: Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
authors.forename: C
authors.initials: C
authors.lastname: Trichot
authors.affiliation: Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN (Group of clinical research in neuro-urology, university Pierre and Marie Curie), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France. Electronic address: thibault.thubert@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Thubert
mesh_terms: D005260:Female; D006801:Humans; D015601:Injury Severity Score; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012307:Risk Factors; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
keywords: Anal incontinence; Anal sphincter injury; Déchirure du 3(e) et 4(e) degrés; Incontinence anale; Pelvic floor rehabilitation; Périnée complet; Réparation chirurgicale; Rééducation périnéale; Surgery; Third and fourth degree tear