Abstract
Introduction and hypothesisOur primary objective was to prospectively evaluate anorectal symptoms, anal manometry and endoanal ultrasound (EAUS) in women who followed the recommended mode of subsequent delivery following index obstetric anal sphincter injuries (OASIs) using our unit’s standardised protocol. Our secondary objectives were to evaluate the role of internal anal sphincter defects and also to compare outcomes in a subgroup of symptomatic women with normal anorectal physiology.MethodsThis is a prospective follow-up study of pregnant women with previous OASIs who were counselled regarding subsequent mode of delivery between January 2003 and December 2014. Assessment involved the St Mark’s Incontinence Score (SMIS), anal manometry and EAUS at both antepartum and 3-month postpartum visits. Data were analysed using Wilcoxon and Mann–Whitney U tests.ResultsThree hundred and fifty women attended the perineal clinic over the study period, of whom 122 met the inclusion criteria (99 vaginal delivery [VD], 23 caesarean section). No significant worsening of anorectal symptoms was observed following subsequent delivery in the VD group (p = 0.896), although a reduced squeeze pressure was observed at 3 months postpartum (p < 0.001). There were no new defects on EAUS in either group.ConclusionsThis study showed no significant worsening of bowel symptoms and sphincter integrity apart from lower squeeze pressures at 3 months postpartum in the VD group when our standardised protocol was used to recommend subsequent mode of delivery. In the absence of a randomised study, use of this protocol can aid clinicians in their decision-making.
Highlights
Introduction and hypothesisOur primary objective was to prospectively evaluate anorectal symptoms, anal manometry and endoanal ultrasound (EAUS) in women who followed the recommended mode of subsequent delivery following index obstetric anal sphincter injuries (OASIs) using our unit’s standardised protocol
The Royal College of Obstetricians and Gynaecologists (RCOG) [7] guideline for the management of third- and fourth-degree tears has recently been updated, but it is interesting to note that the advice regarding management of women in a subsequent pregnancy has not changed, which probably reflects the fact that the evidence base has progressed little since the previous publication in 2007 [8]
A total of 648 women attended the perineal clinic in a subsequent pregnancy over the study period
Summary
Our primary objective was to prospectively evaluate anorectal symptoms, anal manometry and endoanal ultrasound (EAUS) in women who followed the recommended mode of subsequent delivery following index obstetric anal sphincter injuries (OASIs) using our unit’s standardised protocol. Our secondary objectives were to evaluate the role of internal anal sphincter defects and to compare outcomes in a subgroup of symptomatic women with normal anorectal physiology. The Royal College of Obstetricians and Gynaecologists (RCOG) [7] guideline for the management of third- and fourth-degree tears has recently been updated, but it is interesting to note that the advice regarding management of women in a subsequent pregnancy has not changed, which probably reflects the fact that the evidence base has progressed little since the previous publication in 2007 [8]. Small numbers of patients with recurrent OASIs, limited facilities in many centres for performing anorectal physiology testing/anal ultrasound, and ethical issues have restrained rigorous research and implementation of randomised trials
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
