title: Does anal sphincter injury preclude subsequent vaginal delivery?
abstract: OBJECTIVE
  To assess continence and anal sphincter integrity during a subsequent pregnancy and delivery in women known to have a previous anal sphincter injury.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  The National Maternity Hospital, Dublin, Ireland.
  
  
  METHODS
  Antenatal patients with a documented obstetric anal sphincter injury at a previous delivery.
  
  
  METHODS
  Women underwent symptom scoring, endoanal ultrasound and manometry.
  
  
  METHODS
  Recommended and actual mode of delivery, continence scores and endoanal ultrasound findings after index delivery.
  
  
  RESULTS
  557 women were studied. 293 (53%) had no symptoms of faecal incontinence, 189 (34%) had mild symptoms and 75 (13%) moderate or severe symptoms. 408 (73%) had an endoanal ultrasound. 383(94%) had a normal or small (<1 quadrant) defect in the internal anal sphincter and 390 (96%) had a scar or small (<1e quadrant) defect in the external anal sphincter. 393 (70%) delivered vaginally. 164 (30%) were delivered by caesarean section. 197/557 (35%) returned for follow-up. There was no significant change in continence following either vaginal or caesarean delivery. 20 (5.1%) women had a recognised second anal sphincter tear during vaginal delivery.
  
  
  CONCLUSIONS
  The majority of women who sustain a third degree tear have minimal or no symptoms of faecal incontinence when assessed antenatally in a subsequent pregnancy. 70% go on to have a vaginal delivery, with little impact on faecal continence. These findings provide reassurance for patients and clinicians about the safety of vaginal delivery following anal sphincter injury in appropriately selected patients.
authors.affiliation: National Maternity Hospital, Holles Street, Dublin 2, Ireland. Electronic address: myrafitz@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Fitzpatrick
authors.affiliation: National Maternity Hospital, Holles Street, Dublin 2, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Cassidy
authors.affiliation: Service de Chirurgie Digestive, University Hospital of Poitiers, France; Centre for Colorectal Disease, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: M L
authors.initials: ML
authors.lastname: Barassaud
authors.affiliation: National Maternity Hospital, Holles Street, Dublin 2, Ireland.
authors.forename: M P
authors.initials: MP
authors.lastname: Hehir
authors.affiliation: Centre for Colorectal Disease, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: A M
authors.initials: AM
authors.lastname: Hanly
authors.affiliation: Centre for Colorectal Disease, St Vincent's University Hospital, Dublin 4, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Ireland.
authors.forename: P R
authors.initials: PR
authors.lastname: O'Connell
authors.affiliation: National Maternity Hospital, Holles Street, Dublin 2, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: O'Herlihy
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries*; D001720:Birth Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D036861:Delivery, Obstetric; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications; D036801:Parturition / Q000502:physiology*; D011247:Pregnancy; D011446:Prospective Studies
keywords: Endoanal ultrasound; Faecal incontinence; Obstetric anal sphincter injury; Subsequent delivery