Abstract
To the Editors: We appreciate the interest and the comments by Londero, Strolego, and Londero. The objective of our study was to identify risk factors for anal sphincter injury in an attempt to decrease the maternal risk for anal incontinence. We found that an occiput posterior fetal head position (OP) increased the rate of third or fourth degree perineal lacerations compared with an occiput anterior position (OA) in vacuum deliveries. We believe that this information should be considered in counseling patients and when weighing the risks and benefits of an operative delivery from an OP position. The alternative to an operative vaginal delivery would be a cesarean section, and we agree with Londero et al that both maternal and neonatal risks must be considered when making a decision regarding route of delivery. Ideally, conversion of an OP position to OA or prevention of an OP presentation would be ideal. The interventions suggested by Londero et al are interesting; however, we need evidence to suggest that these methods are effective. In the meantime, we recommend considering the maternal morbidity of anal sphincter injury and its sequelae when faced with the decision of performing an operative delivery with an OP presentation.
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