Risk Factors for Anal Continence Impairment Following a Second Delivery after a First Traumatic Delivery: A...

Area of Science:

• Obstetrics and Gynecology
• Pelvic Floor Disorders
• Maternal Health

Background:

• Postpartum anal incontinence is a common complication, particularly after deliveries involving perineal trauma.
• Endoanal sonography (EAS) can identify sphincter injuries, potentially informing decisions about future delivery methods like cesarean section.
• Understanding risk factors for anal continence impairment after a second delivery (D2) is crucial for preventative strategies.

Purpose of the Study:

• To identify risk factors associated with anal continence deterioration following a second delivery (D2) in women with a history of traumatic first delivery (D1).

Main Methods:

• A cohort of 312 women with a history of traumatic D1 were assessed for anal continence using the Vaizey score before and 6 months after D2.
• Risk factors for a significant deterioration (increase ≥2 points) were analyzed.
• Endoanal sonography (EAS) was used to evaluate sphincter integrity after D1.

Main Results:

• Twenty-one percent (67/312) of women experienced worsened anal continence after D2.
• Key risk factors for deterioration included urinary incontinence and the combined use of instruments and episiotomy during D2 (OR 5.12).
• While EAS detected significantly more sphincter ruptures than clinical examination after D1, neither undiagnosed nor severe ruptures were linked to increased continence issues after D2. Cesarean section did not prevent deterioration.

Conclusions:

• Instrumental delivery is the primary risk factor for postpartum anal incontinence after D2.
• Urinary incontinence is a significant indicator for potential anal continence impairment.
• Systematic screening for anal incontinence is recommended in women experiencing urinary incontinence post-D2 due to their frequent association.