Obstetric rectal laceration in the absence of an anal sphincter injury

2021 ◽  
Vol 14 (8) ◽  
pp. e243296
Author(s):  
Adeola Awomolo ◽  
Danielle Hardman ◽  
Adetola Louis-Jacques
Keyword(s):  
Magnesium Sulfate ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
External Anal Sphincter ◽  
Induction Of Labour ◽  
Chronic Hypertension ◽  
Perineal Laceration ◽  
Sphincter Injury ◽  
Spontaneous Vaginal Delivery ◽  
Anal Sphincter Injury

Rectal laceration in the absence of concurrent anal sphincter injury at the time of parturition is not a frequently reported finding. This rarely encountered injury is also referred to as a buttonhole injury. It is a disruption of the vaginal and rectal tissue with resultant disruption of the anal epithelium in the setting of an intact external anal sphincter. A 30-year-old gravida 1 para 0 at 39 weeks presented for induction of labour due to chronic hypertension. During her labour course, she developed with superimposed preeclampsia with severe features and magnesium sulfate was initiated. She underwent a spontaneous vaginal delivery of an infant weighing 3840 g. Following delivery, stool was visualised in the vagina. A rectal examination revealed a rectovaginal defect separate from the second-degree perineal laceration, which extended proximally to the cervix. The anal sphincter was noted to be intact with good tone. Both defects were repaired, and she had an uncomplicated recovery.

scholarly journals Mode of Vaginal Delivery: A Modifiable Intrapartum Risk Factor for Obstetric Anal Sphincter Injury

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Marta Simó González ◽  
Oriol Porta Roda ◽  
Josep Perelló Capó ◽  
Ignasi Gich Saladich ◽  
Joaquim Calaf Alsina
Keyword(s):  
Risk Factor ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
University Hospital ◽  
Obstetric Anal Sphincter Injury ◽  
Vacuum Extraction ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Vaginal Deliveries ◽  
Spontaneous Delivery

The aim of this study was to analyze the comparative risks of this anal sphincter injury in relation to the type of intervention in vaginal delivery. We performed an observational, retrospective study of all vaginal deliveries attended at a tertiary university hospital between January 2006 and December 2009. We analyzed the incidence of obstetric anal sphincter injury for each mode of vaginal delivery: spontaneous delivery, vacuum, Thierry spatulas, and forceps. We determined the proportional incidence between methods taking spontaneous delivery as the reference. Ninety-seven of 4526 (2.14%) women included in the study presented obstetric anal sphincter injury. Instrumental deliveries showed a significantly higher risk of anal sphincter injury (2.7 to 4.9%) than spontaneous deliveries (1.1%). The highest incidence was for Thierry spatulas (OR 4.804), followed by forceps (OR 4.089) and vacuum extraction (OR 2.509). The type of intervention in a vaginal delivery is a modifiable intrapartum risk factor for obstetric anal sphincter injury. Tearing can occur in any type of delivery but proportions vary significantly. All healthcare professionals attending childbirth should be aware of the risk for each type of intervention and consider these together with the obstetric factors in each case.

scholarly journals Predictors of Severe Perineal Tear during Delivery in Yenagoa, Southern Nigeria

2021 ◽  
pp. 42-51
Author(s):  
Ikobho Ebenezer Howells ◽  
Isaac Joel Abasi
Keyword(s):  
Multivariate Analysis ◽  
Birth Weight ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Educational Level ◽  
Odds Ratio ◽  
Mode Of Delivery ◽  
Sphincter Injury ◽  
Perineal Tear ◽  
Anal Sphincter Injury

Background:Perineal tear is a very common complication of vaginal delivery, and it is often mild. However, when severe, it could result in torrential life threatening hemorrhage and anal sphincter injury, with fecal incontinence. Objective: The objective of this study is to determine the predictors of severe perineal tear (3rd and 4th degree tear), using mild perineal tear (1st and 2nd degree) as control. It would also determine the rate of perineal tear, and the maternal and fetal demographic risk factor associated with it. Materials and Methods: This was an analytic observational study of 186 women who had perineal tear during vaginal delivery. Out of these, 19 women had severe (3rd and 4th degree) perineal tear, also known as obstetrics anal sphincter injury (OASI). This was compared to 167 women who had mild perineal tear (1st and 2nd degree) during the study period. Maternal demographic information retrieved was maternal age, parity, educational level, and occupation. Obstetrics factors were booking status, gestational age at delivery, mode of delivery, rank of the accoucheur (nurse or doctor), and degree of perineal tear. Fetal demographic data was birth weight and fetal sex. Categorical variables were compared with odds ratio, difference in mean was compared with student’s t-test, and the degree of association for quantitative variables was determined using Pearson’s correlation coefficient. Predictor variables were determined using simple logistic regression, and multivariate analysis. Confidence interval was set at 95%, and statistical significance was set at p value of < 0.05. Results: The prevalence of OASI (3rd and 4th degree perineal tear) in Yenagoa was 1.1%. The significant risk factors were women of younger age, odds ratio = 1.04(0.37, 2.87) with p = 0.04, low parity, odds ratio = 0.20(0.07, 0.55) with p = 0.008, low educational background, odd ratio = 18.9(5.92, 60.81), and birth weight ≥ 4kg, odds ratio = 0.30[0.09, 1.06] with p = 0.04. Using simple liner regression, the most significant predictors for severe perineal tear were mode delivery (r2 = 65.5%), and educational level (r2 = 30.0%). However, on stepwise multivariate analysis, these two factors accounted for 68.5%. Conclusion: The rate of severe perineal tear is relatively low in Yenagoa, Nigeria, and comparable to what obtains in many countries. The most significant predictors were mode of delivery and educational level. Careful selection of the mode of delivery, especially instrumental vaginal deliveries, and women empowerment could minimize the rate in our environment.

Anal Sphincter Injury Associated with Vaginal Twin Delivery

2019 ◽  
Vol 37 (11) ◽  
pp. 1134-1139
Author(s):  
Bobby D. O'Leary ◽  
Tariq Bholah ◽  
Tamara Kalisse ◽  
Mark P. Hehir ◽  
Michael P. Geary
Keyword(s):  
Risk Factors ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Univariate Analysis ◽  
Mode Of Delivery ◽  
Significant Risk ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Vaginal Deliveries ◽  
Twin Pregnancies

Abstract Objective Obstetric anal sphincter injury remains the most common cause of fecal incontinence in women, and research in twin pregnancies is sparse. This study aimed to examine risk factors for sphincter injury in twin deliveries over a 10-year period. Study Design This was a retrospective study of twin vaginal deliveries in a tertiary-level hospital over 10 years. We examined the demographics of women who had a vaginal delivery of at least one twin. Logistic regression analysis was used to examine risk factors. Results There were 1,783 (2.1%) twin pregnancies, of which 556 (31%) had a vaginal delivery of at least one twin. Sphincter injury occurred in 1.1% (6/556) women with twins compared with 2.9% (1720/59,944) singleton vaginal deliveries. Women with sphincter injury had more instrumental deliveries (83.3 vs. 27.6%; p = 0.008). On univariate analysis, only instrumental delivery was a significant risk factor (odds ratio: 2.93; p = 0.019). Conclusion Sphincter injury occurs at a lower rate in vaginal twin pregnancies than in singletons. No twin-specific risk factors were identified. Discussion of the risk of sphincter injury should form part of patient counseling with regard to the mode of delivery.

Prolonged Second Stage of Labor and Anal Sphincter Injury in a Contemporary Cohort of Term Nulliparas

2020 ◽  
Author(s):  
Mariam Naqvi ◽  
Elana F. Jaffe ◽  
Ilona T. Goldfarb ◽  
Allison S. Bryant ◽  
Blair J. Wylie ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Sphincter Injury ◽  
Predictive Capacity ◽  
Fourth Degree ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Anal Sphincter Injury ◽  
Operative Vaginal Delivery ◽  
Multivariable Regression

Objective This study aimed to assess whether a prolonged second stage of labor is an independent predictor of obstetric anal sphincter injury (OASI) in a contemporary cohort of nulliparous and term parturients, and to evaluate whether predelivery factors can accurately predict OASI. Study Design This was a nested case-control study within a cohort of consecutive nulliparous term parturients with a singleton gestation who underwent a vaginal delivery at a single institution between January 2014 and January 2015. Cases were defined as women with a third- or fourth-degree laceration at the time of delivery, and controls were women without a third- or fourth-degree laceration. A prolonged second stage was defined as a second stage of ≥3 hours. Univariable and multivariable regression analyses were performed to examine the relationship between prolonged second stage of labor and third- or fourth-degree lacerations. Receiver operator curves were developed to assess the predictive capacity of predelivery information for third- and fourth-degree lacerations. Results Of 1,197 births, 63 women had third- or fourth-degree lacerations (5.3%). With each additional hour of the second stage, the rate of OASI increased, with 2.9% of women with a second stage of <1 hour with OASI, 3.5% between 1 and 2 hours, 5.7% between 2 and 3 hours, 7.8% between 3 and 4 hours, 16.1% between 4 and 5 hours, and 28.6% among women with a second stage length >5 hours (p < 0.001). In multivariable regression analysis, operative vaginal delivery (adjusted odds ratio [aOR] = 5.92, 95% confidence interval [CI]: 3.17–11.07) and a prolonged second stage (aOR = 1.92, 95% CI: 1.06–3.51) were independent predictors of third- and fourth-degree lacerations. A predictive model was developed from these results (area under the curve [AUC] = 0.75, 95% CI: 0.68–0.81). Conclusion Prolonged second stage of labor is a predictor of OASI, after adjustment for operative vaginal delivery. A model using predelivery risk factors has a reasonable prediction of OASI. Key Points

Obstetric anal sphincter injury and anal incontinence

2021 ◽  
Vol 86 (2) ◽  
pp. 118-122
Author(s):  
Jan Dvořák ◽  
◽  
Jaromír Mašata ◽  
Kamil Švabík ◽  
Alois Martan
Keyword(s):  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Anal Incontinence ◽  
Vacuum Extraction ◽  
Sphincter Injury ◽  
Assisted Vaginal Delivery ◽  
Anal Sphincter Injury ◽  
Current State ◽  
Complex Approach ◽  
Risk Patients

Overview Objective: The aim of our study is to clarify the problems of OASI (obstetric anal sphincter injuries) and anal incontinence and prevention of this injury. Methods: Review of articles in peer reviewed journals with the usage of Google Scholar function and PubMed. Conclusion: OASI is a severe injury which is more commonly associated with assisted vaginal delivery. This injury cannot be fully prevented, but its incidence can be averted by the usage of selective mediolateral episiotomy, or by other precautionary moves in high risk patients. The treatment of anal incontinence after OASI requires a complex approach and thorough examination. At first delivery, OASI is not a stern indication for caesarean section in accordance with current state of knowledge. Keywords: OASI – sphincter injury – anal incontinence – assisted vaginal delivery – vacuum-extraction – forceps

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