Rectovaginal septal defects after vaginal delivery

Abstract

Objective: Rectoceles are believed to be primarily a consequence of birth trauma. The implication is that the posterior compartment is sometimes not adequately repaired at the time of delivery. The goal of this retrospective study is to assess the rectovaginal septum in patients who had a 3rd- or 4th-degree laceration or four or more children or both. Methods: Digital rectal examinations were performed on 21 women who had sustained a 3rd- or 4th-degree laceration or had four or more children or both. Two physicians examined 15 of the 21 patients. The attachment of the rectovaginal septum to the perineal body was characterized in each patient as completely detached, greater than 50% detached, 50% detached, less than 50% detached, or completely intact. Results: Of the 12 patients with 3rd-degree lacerations, 4 had a complete detachment, 3 had a 50% detachment, 2 had less than 50% detachment, and 3 were intact. All three patients with 4th-degree lacerations were completely intact. There were six patients who had four or more children: three had a complete detachment, one greater than 50%, and two were intact. Of the nine primiparous patients, seven had 3rd-degree lacerations and two had 4th-degree lacerations. Of the seven primiparous women with 3rd-degree lacerations, one was completely detached, three were 50% detached, two were less than 50% detached, and one was intact. The two examiners’ assessments of the rectovaginal septum were in agreement in all but one patient. Conclusion: This pilot study suggests that patients with 3rd-degree lacerations may be at risk for unrecognized and unrepaired detachment of the rectovaginal septum from the perineal body. Traditional repair of the 4th-degree laceration may protect from persistent defects in the rectovaginal septum.