BJOG : an international journal of obstetrics and gynaecology · 2026
Anal Incontinence in Primiparous Women With Second- to Fourth-Degree Perineal Tears One Year After Vaginal Delivery: Development and Validation of a Multivariable Prediction Model.
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Josefsson Mette L, Lampa Erik, Uustal Eva, Sohlberg Sara, Ekéus Cecilia, Jonsson Maria
Аннотация
OBJECTIVE: To develop and validate a prediction model estimating the individual risk of anal incontinence 1 year postpartum following second-, third- and fourth-degree perineal tears.
DESIGN: Development of a prognostic prediction model.
SETTING: Data were retrieved from three Swedish health and quality registers.
POPULATION: 8909 primiparous women with second-, third- and fourth-degree perineal tears who delivered vaginally at ≥ 34 weeks' gestation between 2014 and 2019.
METHODS: Seventeen predictors were identified as candidate variables. A prediction model was built using logistic regression to predict anal incontinence at 1 year postpartum. Additional models were built for gas and faecal incontinence. Model performance was assessed using the Efron-Gong optimism bootstrap. Temporal validation was conducted in a separate cohort of women who delivered between 2020 and 2022.
MAIN OUTCOME MEASURE: Anal incontinence (gas and/or faecal incontinence) at 1 year postpartum.
RESULTS: Seven variables remained in the final model for anal incontinence. A high Wexner score was the strongest predictor of anal incontinence at 1 year postpartum. The models accurately predicted anal incontinence (AUC 0.78, 95% CI: 0.76-0.80), faecal incontinence (AUC 0.80, 95% CI: 0.77-0.83), and gas incontinence (AUC 0.78, 95% CI: 0.76-0.80). Calibration curves demonstrated that all models were accurate, particularly for women with third-degree tears. Temporal validation confirmed the high accuracy (AUC 0.78; 95% CI: 0.75-0.81).
CONCLUSIONS: The article presents an accurate prediction model for anal incontinence at 1 year after vaginal delivery among women with second-, third- and fourth-degree perineal tears, based on perineal laceration register data collected at 8 weeks postpartum.
DESIGN: Development of a prognostic prediction model.
SETTING: Data were retrieved from three Swedish health and quality registers.
POPULATION: 8909 primiparous women with second-, third- and fourth-degree perineal tears who delivered vaginally at ≥ 34 weeks' gestation between 2014 and 2019.
METHODS: Seventeen predictors were identified as candidate variables. A prediction model was built using logistic regression to predict anal incontinence at 1 year postpartum. Additional models were built for gas and faecal incontinence. Model performance was assessed using the Efron-Gong optimism bootstrap. Temporal validation was conducted in a separate cohort of women who delivered between 2020 and 2022.
MAIN OUTCOME MEASURE: Anal incontinence (gas and/or faecal incontinence) at 1 year postpartum.
RESULTS: Seven variables remained in the final model for anal incontinence. A high Wexner score was the strongest predictor of anal incontinence at 1 year postpartum. The models accurately predicted anal incontinence (AUC 0.78, 95% CI: 0.76-0.80), faecal incontinence (AUC 0.80, 95% CI: 0.77-0.83), and gas incontinence (AUC 0.78, 95% CI: 0.76-0.80). Calibration curves demonstrated that all models were accurate, particularly for women with third-degree tears. Temporal validation confirmed the high accuracy (AUC 0.78; 95% CI: 0.75-0.81).
CONCLUSIONS: The article presents an accurate prediction model for anal incontinence at 1 year after vaginal delivery among women with second-, third- and fourth-degree perineal tears, based on perineal laceration register data collected at 8 weeks postpartum.