BJOG : an international journal of obstetrics and gynaecology · 2004
Rupture of the sphincter ani: the recurrence rate in second delivery.
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Elfaghi Ibtesam, Johansson-Ernste Birgit, Rydhstroem Hakan
Аннотация
BACKGROUND: Injury to the genital tract sustained during childbirth can lead to transient or protracted morbidity. Attention should be paid to avoidable risk factors that can cause this complication.
AIM: To analyse the recurrence, at a later delivery, of trauma to the genital tract, subsequent to perineal laceration of the sphincter ani (third or fourth degree), sustained at an earlier delivery.
DESIGN: A population-based study.
SETTING: In Sweden, 1973-1997 inclusive.
POPULATION: All women with a vaginal, singleton delivery in Sweden.
METHODS: The Medical Birth Registry, the National Board of Health and Welfare, was used to identify cases of ruptured sphincter ani.
MAIN OUTCOME MEASURES: OR was calculated with 95% confidence interval. A stratified analysis was performed using the Mantel-Haenszel technique. Major end point Rupture of the sphincter ani (third or fourth degree) at second delivery.
RESULTS: The incidence of anal sphincter rupture increased sixfold during the study period, from 0.5% in 1973 to 3.0% in 1997. Women who had sustained a laceration of this type ran a significantly increased risk of a recurrence at a later delivery. This effect persisted even after stratification for birthweight, year of birth, parity and maternal age (OR 4.74, 95% confidence interval 4.34-5.17). When only fourth degree rupture was considered (rupture of both anal sphincter and rectum), the corresponding figures were 6.52 (95% CI 5.29-8.04). This effect also persisted after stratification for birthweight, year of birth, parity and maternal age. The OR for giving birth a second time, subsequent to a third or fourth degree perineal laceration at first delivery, was 0.68 (95% CI 0.67-0.70).
CONCLUSION: Our findings suggest that the risk of an anal sphincter rupture at delivery increases five to sevenfold when there has been a similar rupture at a previous delivery. Further study is needed before safe recommendations can be made concerning the subsequent mode of delivery to be adopted, following rupture in the sphincter ani at a previous birth.
AIM: To analyse the recurrence, at a later delivery, of trauma to the genital tract, subsequent to perineal laceration of the sphincter ani (third or fourth degree), sustained at an earlier delivery.
DESIGN: A population-based study.
SETTING: In Sweden, 1973-1997 inclusive.
POPULATION: All women with a vaginal, singleton delivery in Sweden.
METHODS: The Medical Birth Registry, the National Board of Health and Welfare, was used to identify cases of ruptured sphincter ani.
MAIN OUTCOME MEASURES: OR was calculated with 95% confidence interval. A stratified analysis was performed using the Mantel-Haenszel technique. Major end point Rupture of the sphincter ani (third or fourth degree) at second delivery.
RESULTS: The incidence of anal sphincter rupture increased sixfold during the study period, from 0.5% in 1973 to 3.0% in 1997. Women who had sustained a laceration of this type ran a significantly increased risk of a recurrence at a later delivery. This effect persisted even after stratification for birthweight, year of birth, parity and maternal age (OR 4.74, 95% confidence interval 4.34-5.17). When only fourth degree rupture was considered (rupture of both anal sphincter and rectum), the corresponding figures were 6.52 (95% CI 5.29-8.04). This effect also persisted after stratification for birthweight, year of birth, parity and maternal age. The OR for giving birth a second time, subsequent to a third or fourth degree perineal laceration at first delivery, was 0.68 (95% CI 0.67-0.70).
CONCLUSION: Our findings suggest that the risk of an anal sphincter rupture at delivery increases five to sevenfold when there has been a similar rupture at a previous delivery. Further study is needed before safe recommendations can be made concerning the subsequent mode of delivery to be adopted, following rupture in the sphincter ani at a previous birth.