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Anal sphincter disruption at vaginal delivery: is recurrence predictable?
Rosemary Harkin1, Myra Fitzpatrick, P Ronan O'Connell
1Department of Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Holles Street, Dublin 2, Ireland.
Summary
The risk of third-degree tear recurrence after vaginal delivery is low (4.4%), even with a history of sphincter injury. Antepartum anal function testing cannot predict recurrence, offering reassurance for future deliveries.
Area of Science:
- Obstetrics and Gynecology
- Colorectal Surgery
- Pelvic Floor Disorders
Background:
- Third-degree tears, or anal sphincter disruptions, are severe obstetric injuries.
- Risk of recurrence in subsequent pregnancies is a significant concern for affected women.
Purpose of the Study:
- To evaluate the recurrence risk of third-degree tears in subsequent vaginal deliveries.
- To determine if antepartum anal functional assessment can predict tear recurrence.
Main Methods:
- Prospective evaluation of 20,111 vaginal deliveries, identifying 342 (1.7%) third-degree tears.
- Postpartum anal manometry and endosonography performed on all women with tears.
- Antepartum and postpartum testing repeated in 56 women for subsequent deliveries.
Main Results:
- Third-degree tears recurred in 2 (4.4%) of 45 women undergoing repeat vaginal delivery.
- Recurrent tears occurred in asymptomatic women with normal antepartum manometry.
- No significant difference in recurrence based on delivery mode (spontaneous vs. assisted).
Conclusions:
- While the risk of recurrence is elevated compared to the general multiparous population, 95% of women with a history of third-degree tears do not experience recurrence upon vaginal delivery.
- Antepartum anal physiology testing is not a reliable predictor of third-degree tear recurrence.