Skip to main content

Advertisement

SpringerLink
Log in

Obstetric anal sphincter injuries in vaginal delivery of twins: associated risk factors and comparison with singletons

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Risk factors related to obstetric anal sphincter injuries (OASIS) are known for singleton deliveries. No study to date has described the rate and risk factors involved in twin deliveries.

Methods

We conducted a retrospective cohort study (1985–2010) of all vaginal twin and singleton deliveries in a single tertiary center. The adjusted odds ratio (OR) for OASIS at delivery was estimated using the logistic regression model.

Results

The study comprised 1,538 and 91,312 patients with vaginal twin and singleton delivery, respectively. Twenty twin (1.27 %) and 2,331 (2.55 %) singleton deliveries were complicated with OASIS. The following OASIS-associated risk factors were shared by both populations: nulliparity [twins adjusted OR 5.9, 95 % confidence interval (CI) 1.7–20.9; singletons adjusted OR 3.9, 95 % CI 3.5–4.4), occipitoposterior (OP) position (twins adjusted OR 3.00, 95 % CI 1.1–8.0; singletons adjusted OR 1.6, 95 % CI 1.3–2.00), birthweight (for each 100 g) (twin adjusted OR 1.1, 95 % CI 1.0–1.2; singletons adjusted OR 1.07, 95 % CI 1.06–1.08), and instrumental delivery (twins adjusted OR 4.3, 95 % CI 1.2–15.4, singletons adjusted OR 2.4, 95 % CI 2.2–2.6).

Conclusions

Risk factors of nulliparity, OP position, large fetal size, and instrumental delivery were shared by both twin and singleton deliveries. These data will be useful in counselling women carrying twins who intend to deliver vaginally.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baud D, Meyer S, Vial Y, Hohlfeld P, Achtari C (2011) Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery. Int Urogynecol J 22(9):1127–1134

    Article  PubMed  Google Scholar 

  2. Elfaghi I, Johansson-Ernste B, Rydhstroem H (2004) Rupture of the sphincter ani: the recurrence rate in second delivery. BJOG 111(12):1361–1364

    Article  PubMed  Google Scholar 

  3. Payne TN, Carey JC, Rayburn WF (1999) Prior third- or fourth-degree perineal tears and recurrence risks. Int J Gynaecol Obstet 64(1):55–57

    Article  PubMed  CAS  Google Scholar 

  4. Sangalli MR, Floris L, Faltin D, Weil A (2000) Anal incontinence in women with third or fourth degree perineal tears and subsequent vaginal deliveries. Aust N Z J Obstet Gynaecol 40(3):244–248

    Article  PubMed  CAS  Google Scholar 

  5. Aukee P, Sundstrom H, Kairaluoma MV (2006) The role of mediolateral episiotomy during labour: analysis of risk factors for obstetric anal sphincter tears. Acta Obstet Gynecol Scand 85(7):856–860

    Article  PubMed  Google Scholar 

  6. Dahlen HG, Ryan M, Homer CS, Cooke M (2007) An Australian prospective cohort study of risk factors for severe perineal trauma during childbirth. Midwifery 23(2):196–203

    Article  PubMed  Google Scholar 

  7. Dandolu V, Chatwani A, Harmanli O, Floro C, Gaughan JP, Hernandez E (2005) Risk factors for obstetrical anal sphincter lacerations. Int Urogynecol J Pelvic Floor Dysfunct 16(4):304–307

    Article  PubMed  Google Scholar 

  8. de Leeuw JW, Struijk PC, Vierhout ME, Wallenburg HC (2001) Risk factors for third degree perineal ruptures during delivery. BJOG 108(4):383–387

    PubMed  Google Scholar 

  9. Eason E, Labrecque M, Marcoux S, Mondor M (2002) Anal incontinence after childbirth. CMAJ 166(3):326–330

    PubMed  Google Scholar 

  10. Eskandar O, Shet D (2009) Risk factors for 3rd and 4th degree perineal tear. J Obstet Gynaecol 29(2):119–122

    Article  PubMed  CAS  Google Scholar 

  11. Gareberg B, Magnusson B, Sultan B, Wennerholm UB, Wennergren M, Hagberg H (1994) Birth in standing position: a high frequency of third degree tears. Acta Obstet Gynecol Scand 73(8):630–633

    Article  PubMed  CAS  Google Scholar 

  12. Groutz A, Hasson J, Wengier A et al (2011) Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium. Am J Obstet Gynecol 204(4):347 e1–e4

    Article  Google Scholar 

  13. Hamilton EF, Smith S, Yang L, Warrick P, Ciampi A (2011) Third- and fourth-degree perineal lacerations: defining high-risk clinical clusters. Am J Obstet Gynecol 204(4):309 e1–e6

    Article  Google Scholar 

  14. Hudelist G, Gelle’n J, Singer C et al (2005) Factors predicting severe perineal trauma during childbirth: role of forceps delivery routinely combined with mediolateral episiotomy. Am J Obstet Gynecol 192(3):875–881

    Article  PubMed  Google Scholar 

  15. Jander C, Lyrenas S (2001) Third and fourth degree perineal tears. Predictor factors in a referral hospital. Acta Obstet Gynecol Scand 80(3):229–234

    PubMed  CAS  Google Scholar 

  16. Labrecque M, Baillargeon L, Dallaire M, Tremblay A, Pinault JJ, Gingras S (1997) Association between median episiotomy and severe perineal lacerations in primiparous women. CMAJ 156(6):797–802

    PubMed  CAS  Google Scholar 

  17. Poen AC, Felt-Bersma RJ, Dekker GA, Deville W, Cuesta MA, Meuwissen SG (1997) Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy. Br J Obstet Gynaecol 104(5):563–566

    Article  PubMed  CAS  Google Scholar 

  18. Samarasekera DN, Bekhit MT, Preston JP, Speakman CT (2009) Risk factors for anal sphincter disruption during child birth. Langenbecks Arch Surg 394(3):535–538

    Article  PubMed  CAS  Google Scholar 

  19. Samuelsson E, Ladfors L, Wennerholm UB, Gareberg B, Nyberg K, Hagberg H (2000) Anal sphincter tears: prospective study of obstetric risk factors. BJOG 107(7):926–931

    Article  PubMed  CAS  Google Scholar 

  20. Andrews V, Sultan AH, Thakar R, Jones PW (2006) Occult anal sphincter injuries–myth or reality? BJOG 113(2):195–200

    Article  PubMed  Google Scholar 

  21. Walker MP, Farine D, Rolbin SH, Ritchie JW (1991) Epidural anesthesia, episiotomy, and obstetric laceration. Obstet Gynecol 77(5):668–671

    PubMed  CAS  Google Scholar 

  22. Millar WJ, Wadhera S, Nimrod C (1992) Multiple births: trends and patterns in Canada, 1974–1990. Health Rep 4(3):223–250

    PubMed  CAS  Google Scholar 

  23. Bolt P, Clerk AN, Luu HH et al (2007) BMP-14 gene therapy increases tendon tensile strength in a rat model of Achilles tendon injury. J Bone Joint Surg Am 89(6):1315–1320

    Article  PubMed  Google Scholar 

  24. Laine K, Gissler M, Pirhonen J (2009) Changing incidence of anal sphincter tears in four Nordic countries through the last decades. Eur J Obstet Gynecol Reprod Biol 146(1):71–75

    Article  PubMed  Google Scholar 

  25. Takeda U, Utani A, Wu J et al (2002) Targeted disruption of dermatopontin causes abnormal collagen fibrillogenesis. J Invest Dermatol 119(3):678–683

    Article  PubMed  CAS  Google Scholar 

  26. Uitto J, Hsu-Wong S, Katchman SD, Bashir MM, Rosenbloom J (1995) Skin elastic fibres: regulation of human elastin promoter activity in transgenic mice. Ciba Found Symp 192:237–553, discussion 53–58

    PubMed  CAS  Google Scholar 

  27. Wang H, Parry S, Macones G et al (2006) A functional SNP in the promoter of the SERPINH1 gene increases risk of preterm premature rupture of membranes in African Americans. Proc Natl Acad Sci U S A 103(36):13463–13467

    Article  PubMed  CAS  Google Scholar 

  28. Yeowell HN, Walker LC (2000) Mutations in the lysyl hydroxylase 1 gene that result in enzyme deficiency and the clinical phenotype of Ehlers-Danlos syndrome type VI. Mol Genet Metab 71(1–2):212–224

    Article  PubMed  CAS  Google Scholar 

  29. Boucoiran I, Valerio L, Bafghi A, Delotte J, Bongain A (2010) Spatula-assisted deliveries: a large cohort of 1065 cases. Eur J Obstet Gynecol Reprod Biol 151(1):46–51

    Article  PubMed  Google Scholar 

  30. DiPiazza D, Richter HE, Chapman V et al (2006) Risk factors for anal sphincter tear in multiparas. Obstet Gynecol 107(6):1233–1237

    Article  PubMed  Google Scholar 

  31. Richter HE, Brumfield CG, Cliver SP, Burgio KL, Neely CL, Varner RE (2002) Risk factors associated with anal sphincter tear: a comparison of primiparous patients, vaginal births after cesarean deliveries, and patients with previous vaginal delivery. Am J Obstet Gynecol 187(5):1194–1198

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

David Baud is supported by the Société Académique Vaudoise through the Paul Blanc grant, the SICPA Foundation, Air Canada Travel Grant, and the Rotary International Foundation.

Details of ethics approval

The study was approved by the institutional research ethics board on 21 November 2011; reference REB number 11-0273-C.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 600 University Ave, Toronto, ON, M5G 1X5, Canada

    Shay Porat, David Baud & Dan Farine

Authors
  1. Shay Porat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Baud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dan Farine
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shay Porat.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Porat, S., Baud, D. & Farine, D. Obstetric anal sphincter injuries in vaginal delivery of twins: associated risk factors and comparison with singletons. Int Urogynecol J 24, 769–774 (2013). https://doi.org/10.1007/s00192-012-1923-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-012-1923-8

Keywords

Search

Navigation