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 18 February 2018

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News

Risk factors of obstetric anal sphincter injury

The most recent issue of the Annals of Surgery examines the incidence, risk factors, and management of obstetric anal sphincter injury.

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Obstetric sphincter damage is the most common cause of fecal incontinence in women.

Dr Thomas Dudding and colleagues from the United Kingdom surveyed the literature, and reached a consensus, on its incidence, risk factors, and management.

The team identified relevant studies from Medline, Cochrane database, cross referencing from identified articles, and conference abstracts and proceedings

Episiotomy was a risk factor for anal sphincter injury
Annals of Surgery

The research team searched guidelines published by the National Institute of Clinical Excellence, Royal College of Obstetricians and Gynaecologists, and American College of Obstetricians and Gynecologists.

The researcher reviewed a total of 451 articles and abstracts.

There was a wide variation in the reported incidence of anal sphincter muscle injury from childbirth.

The research team noted that the true incidence was likely to be 11% of postpartum women.

The researchers found that risk factors for injury included instrumental delivery, and prolonged second stage of labour.

The research team noted that birth weight greater than 4 kg, fetal occipitoposterior presentation, and episiotomy were risk factors.

First vaginal delivery, induction of labor, epidural anesthesia, early pushing, and active restraint of the fetal head during delivery may be associated with an increased risk of sphincter trauma.

The team found the majority of sphincter tears can be identified clinically by a suitably trained clinician.

In those with recognized tears at the time of delivery repair should be performed using long-term absorbable sutures.

The team found patients presenting later with fecal incontinence may be managed successfully using antidiarrheal drugs and biofeedback.

In those who fail conservative treatment, and who have a substantial sphincter disruption, elective repair may be attempted.

The team found the results of primary and elective repair may deteriorate with time.

Sacral nerve stimulation may be an appropriate alternative treatment modality.

Dr Dudding‘s team concluded, "Obstetric anal sphincter damage, and related fecal incontinence, are common."

"Risk factors for such trauma are well recognized, and should allow for reduction of injury by proactive management."

"Improved classification, recognition, and follow-up of at-risk patients should facilitate improved outcome."

"Further studies are required to determine optimal long-term management."

Ann Surg 2008: 247(2): 224-37
12 February 2008

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