OP34.10: Rate of incontinence at long follow‐up of women after III° and IV° intrapartum sphincter tears with normal ultrasound, are similar to women following normal delivery

Abstract

Objectives: 3D transperineal ultrasound (3DTUS) examination performed in women following III◦ or IV◦ intrapartum tears repaired with the overlapping technique demonstrates characteristic sonographic signs. The aim of the present study was to examine the possible correlation of these signs with clinical complaints of incontinence. Methods: Prospective observational study. 60 primiparous women underwent 3DTUS follow up 3–42 months after surgical repair of III◦ or IV◦ postpartum sphincter tears with overlapping technique and were evaluated for clinical degree of incontinence with the St. Mark’s incontinence score (SMIS) questionnaire. 27 primiparous women after normal vaginal delivery, without clinically recognized anal sphincter tears, were similarly evaluated 3–37 months postpartum as a comparison group. Results: Sonographic signs were apparent in 35/60 (58.3%) women; 39/60 (65%) had some clinical complaints of incontinence 3–42 months after delivery, most of mild degree. Rates of incontinence were similar between the late examination group with normal U/S and the comparison group (9/25 vs. 10/27, respectively, RR 0.97, 95% CI 0.47–1.97). Significantly higher rate of clinical complaints was found in women with abnormal US (RR 2.38, 95% CI, 1.49–4.29). Conclusions: Sonographic signs of anal sphincter tear and repair disappeared in almost half of patients: this examination should be deferred from the early postpartum period. A substantial proportion of women after sphincter repair report some complaint of incontinence, most of slight degree. Such complaints are associated with abnormal late 3DTUS findings, while in women with normal late 3DTUS the rate of incontinence complaints is similar to women after normal delivery.