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Does anal sphincter injury preclude subsequent vaginal delivery?
M Fitzpatrick1, M Cassidy1, M L Barassaud2
1National Maternity Hospital, Holles Street, Dublin 2, Ireland.
European Journal of Obstetrics, Gynecology, and Reproductive Biology
|January 17, 2016
Summary
Most women with previous anal sphincter injury experience minimal fecal incontinence during subsequent pregnancies. Vaginal delivery is safe for many, with little impact on continence, offering reassurance for patients and clinicians.
Area of Science:
- Obstetrics and Gynecology
- Colorectal Surgery
- Pelvic Floor Disorders
Background:
- Obstetric anal sphincter injuries (OASIS) can lead to long-term fecal incontinence.
- Assessing continence and anal sphincter integrity in subsequent pregnancies is crucial for management.
Purpose of the Study:
- To evaluate anal sphincter integrity and continence in women with a history of OASIS during a subsequent pregnancy and delivery.
- To provide data on the safety and outcomes of different delivery modes following OASIS.
Main Methods:
- Prospective observational study involving 557 women with prior OASIS.
- Antenatal assessment included symptom scoring, endoanal ultrasound, and manometry.
- Delivery mode, continence scores, and ultrasound findings post-delivery were recorded.
Main Results:
- 53% of women reported no fecal incontinence symptoms antenatally.
- Endoanal ultrasound revealed minimal sphincter defects in most women (94-96%).
- 70% had vaginal deliveries with no significant change in continence; 5.1% sustained a new tear.
Conclusions:
- The majority of women with prior OASIS have minimal or no fecal incontinence symptoms in subsequent pregnancies.
- Vaginal delivery is a safe option for most, with little impact on continence.
- Findings offer reassurance for patients and clinicians regarding vaginal delivery after OASIS.