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Obstetrics & Gynecology 1999;94:21-28
© 1999 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Anal Sphincter Tears at Vaginal Delivery: Risk Factors and Clinical Outcome of Primary Repair

JAN ZETTERSTRÖM, MD, ANNIKA LÓPEZ, MD, BO ANZÉN, MD, PhD, MARGARETA NORMAN, MD, PhD, BO HOLMSTRÖM, MD, PhD and ANDERS MELLGREN, MD, PhD

From the Divisions of Obstetrics & Gynaecology and Surgery, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.

Address reprint requests to: Jan Zetterström, MD, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, S-182 88 Danderyd, Sweden.

Objective: To determine risk factors for obstetric anal sphincter tears and to evaluate symptomatic outcome of primary repair.

Methods: Obstetric-procedure, maternal, and fetal data were registered in 845 consecutive vaginally delivered women. Risk factors for anal sphincter tears were calculated by multiple logistic regression. All 808 Swedish-speaking women who delivered vaginally were included in a questionnaire study regarding anal incontinence in relation to the delivery. Questionnaires were distributed within the first few days postpartum, and at 5 and 9 months postpartum.

Results: Six percent of the women had a clinically detected sphincter tear at delivery. Sphincter tears were associated with nulliparity (odds ratio [OR] 9.8, 95% confidence interval [CI] 3.6, 26.2), postmaturity (OR 2.5, 95% CI 1.0, 6.2), fundal pressure (OR 4.6 95% CI 2.3, 7.9), midline episiotomy (OR 5.5 95% CI 1.4, 18.7), and fetal weight in intervals of 250 g (OR 1.3 95% CI 1.1, 1.6). Fifty-four percent of women with repaired sphincter tears suffered from fecal or gas incontinence or both at 5 months and 41% at 9 months. Most of the symptoms were infrequent and mild.

Conclusion: Several risk factors for sphincter tear were identified. Sphincter tear at vaginal delivery is a serious complication, and it is frequently associated with anal incontinence. Special attention should be directed toward risk factors for this complication. Symptoms of anal incontinence should explicitly be sought at follow-up after delivery.




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