A dynamic prediction score for obstetric anal sphincter injury among nulliparous women delivering vaginally

2021 ◽  
Author(s):  
Raanan Meyer ◽  
Anat Schwartz ◽  
Nir Horesh ◽  
Menachem Alcalay ◽  
Edward Ram ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Prediction Score ◽  
Obstetric Anal Sphincter Injury ◽  
Sphincter Injury ◽  
Dynamic Prediction ◽  
Anal Sphincter Injury ◽  
Nulliparous Women

scholarly journals Prevalence and Risk Indicators for Anal Incontinence among Pregnant Women

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Katariina Laine ◽  
Finn Egil Skjeldestad ◽  
Leiv Sandvik ◽  
Anne Cathrine Staff
Keyword(s):  
Urinary Incontinence ◽  
Pregnant Women ◽  
Anal Sphincter ◽  
Anal Incontinence ◽  
Ultrasound Examination ◽  
Obstetric Anal Sphincter Injury ◽  
Minor Effect ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Nulliparous Women

The aim of this study was to assess the prevalence and risk factors of anal incontinence in an unselected pregnant population at second trimester. A survey of pregnant women attending a routine ultrasound examination was conducted in a university hospital in Oslo, Norway. A questionnaire consisting of 105 items concerning anal incontinence (including St. Mark’s score), urinary incontinence, medication use, and comorbidity was posted to women when invited to the ultrasound examination. Results. Prevalence of self-reported anal incontinence (St. Mark’s score ≥ 3) was the lowest in the group of women with a previous cesarean section only (6.4%) and the highest among women with a previous delivery complicated by obstetric anal sphincter injury (24.4%). Among nulliparous women the prevalence of anal incontinence was 7.7% and was associated to low educational level and comorbidity. Prevalence of anal incontinence increased with increasing parity. Urinary incontinence was associated with anal incontinence in all parity groups. Conclusions. Anal incontinence was most frequent among women with a history of obstetric anal sphincter injury. Other obstetrical events had a minor effect on prevalence of anal incontinence among parous women. Prevention of obstetrical sphincter injury is likely the most important factor for reducing bothersome anal incontinence among fertile women.

scholarly journals Lateral episiotomy versus no episiotomy to reduce obstetric anal sphincter injury in vacuum-assisted delivery in nulliparous women: study protocol on a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025050 ◽  
Author(s):  
Sandra Bergendahl ◽  
Victoria Ankarcrona ◽  
Åsa Leijonhufvud ◽  
Susanne Hesselman ◽  
Sofie Karlström ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Anal Sphincter ◽  
Controlled Trial ◽  
Obstetric Anal Sphincter Injury ◽  
Vacuum Extraction ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Nulliparous Women ◽  
Assisted Delivery ◽  
Randomised Controlled

IntroductionObstetric anal sphincter injury (OASIS) occurs in 5%–7% of normal deliveries and increases with vacuum extraction (VE) to 12%–14% in nulliparous women in Sweden. Lateral/mediolateral episiotomy may reduce the prevalence of OASIS at VE in nulliparous women. The current use of episiotomy is restrictive. The protective effect and consequences are uncertain. This trial will investigate if lateral episiotomy can reduce the prevalence of OASIS and assess short-term and long-term effects.Methods and analysisThis is a multicentre randomised controlled trial of lateral episiotomy versus no episiotomy in nulliparous women with a singleton, live fetus, after gestational week 34+0 with indication for VE. A lateral episiotomy of 4 cm is cut at crowning, 1–3 cm from the midline, at a 60° angle. The primary outcome is OASIS by clinical diagnosis analysed according to intention to treat. To demonstrate a 50% reduction in OASIS prevalence (from 12.4% to 6.2%), 710 women will be randomised at a 1:1 ratio. Secondary outcomes are pain, blood loss, other perineal injuries, perineal complications, Apgar score, cord pH and neonatal complications. Web-based questionnaires at baseline, 2 months, 1 and 5 years will be used to assess pain, incontinence, prolapse, sexual function, quality of life and childbirth experience. A subset of women will receive follow-up by pelvic floor sonography and pelvic examination. Mode of delivery and recurrence of OASIS/episiotomy in subsequent pregnancies will be assessed at 5 and 10 years using register data.Ethics and disseminationThe trial is open for enrolment. The trial has received ethical approval from the Regional Ethical Review Board of Stockholm and full funding from the Swedish Research Council. Women are interested in participation. The predominant restrictive view on episiotomy may limit recruitment. Results are of global interest and will be disseminated in peer-reviewed journals and at international congresses.Trial registration numberNCT02643108; Pre-results.

Sign in / Sign up

Export Citation Format

Share Document