Third-degree obstetric perineal tear: long-term clinical and functional results after primary repair

Author:

Poen A C12,Felt-Bersma R J F12,Strijers R L M3,Dekker G A4,Cuesta M A2,Meuwissen S G M1

Affiliation:

1. Department of Gastroenterology, University Hospital ‘Vrije Universiteit’, Amsterdam, The Netherlands

2. Department of Surgery, University Hospital ‘Vrije Universiteit’, Amsterdam, The Netherlands

3. Department of Clinical Neurophysiology, University Hospital ‘Vrije Universiteit’, Amsterdam, The Netherlands

4. Department of Obstetrics and Gynaecology, University Hospital ‘Vrije Universiteit’, Amsterdam, The Netherlands

Abstract

Abstract Background This study was designed to investigate the long-term clinical and anorectal functional results after primary repair of a third-degree obstetrical perineal rupture. Methods One hundred and fifty-six consecutive women who had a primary repair of a third-degree perineal rupture were sent a questionnaire and asked to undergo anorectal function testing (anal manometry, anorectal sensitivity, anal endosonography and pudendal nerve terminal motor latency (PNTML)) Results Some 117 women (75 per cent) responded. Anal incontinence was present in 47 women (40 per cent); however, in most cases only mild symptoms were present. In 40 women additional anorectal function tests were performed and compared with findings in normal controls. Mean(s.d.) maximum squeeze pressure (31(15) versus 63(17) mmHg, P<0·001) was decreased and first sensation to filling of the rectum (88(47) versus 66(33) ml, P = 0·03) and anal mucosal electrosensitivity (4·7(1·7) versus 2·5(0·8) mA, P = 0·003) were increased compared with values in normal controls. In 35 women (88 per cent) a sphincter defect was found with anal endosonography. Factors related to anal incontinence were the presence of a combined anal sphincter defect (relative risk (RR) 1·7 (95 per cent confidence interval (c.i.) 1·1–2·8)) or subsequent vaginal delivery (RR 1·6 (95 per cent c.i. 1·1–2·5)). Conclusion Anal incontinence prevails in 40 per cent of women 5 years after primary repair of a third-degree perineal rupture. The presence of a combined sphincter defect or subsequent vaginal delivery increase the risk of anal incontinence.

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference31 articles.

1. Community-based prevalence of anal incontinence;Nelson;JAMA,1995

2. Incidence of third-degree perineal tears in labour and outcome after primary repair;Walsh;Br J Surg,1996

3. Anatomic and functional results of surgical repair after total perineal rupture at delivery;Go;Surg Gynecol Obstet,1988

4. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair;Sultan;BMJ,1994

5. Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy;Poen;Br J Obstet Gynaecol,1997

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