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Do routinely measured delivery variables predict anal sphincter outcome?

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Trauma to the anal sphincter is a recognized complication of primiparous childbirth. This damage may be compounded during subsequent deliveries leading to symptoms. Earlier work is inconclusive as to which delivery variables are associated with such damage and may prove useful in predicting its occurrence, thereby allowing the potential for intervention in these later deliveries to protect the traumatized anal sphincter. The purpose of the present study was to determine whether routinely recorded obstetric variables can be correlated to anal sphincter damage in a consecutive series of females. METHODS: A prospective study was undertaken in a single maternity unit. Patients delivering were assessed before discharge using a symptom questionnaire and endoanal ultrasound. Delivery data were collected prospectively and analyzed statistically to see if a significant difference existed in the presence of an anal sphincter defect. RESULTS: A total of 159 patients were assessed. Endosonography revealed sphincter injuries in 8.7 percent of the normal vaginal delivery group and 83 percent of the forceps delivery group. No correlation was found between head circumference, baby weight, maternal body mass index, epidurals, episiotomy, length of each stage of labor, and duration of active pushing. Forceps delivery was the only factor to be significantly associated with sphincter trauma. CONCLUSION: Besides forceps delivery, commonly measured delivery variables are not useful predictors of anal sphincter trauma. Normal vaginal deliveries do not warrant routine postnatal anorectal assessment. but this should be routine for all instrument deliveries.

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Authors and Affiliations

  1. Academic Department of Obstetrics and Gynaecology, Hull Maternity Hospital, East Yorkshire

    James Gunn (F.R.C.S.) &  Graeme S. Duthie M.D.(Hons) (F.R.C.S.(Edinb.)

  2. The University of Hull Postgraduate Medical School, Hull, United Kingdom

    Steven W. Lindow M.Med.(O&G) (M.R.C.O.G., F.R.C.O.G.(SA)

  3. Academic Surgical Unit, Castle Hill Hospital, Castle Road, HU16 5JQ, Cottingham, East Yorkshire, United Kingdom

    Aarti Varma M.B. Ch.B. &  Graeme S. Duthie M.D.(Hons) (F.R.C.S.(Edinb.)

Authors
  1. Aarti Varma M.B. Ch.B.
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  2. James Gunn
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  3. Steven W. Lindow M.Med.(O&G)
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  4. Graeme S. Duthie M.D.(Hons)
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Additional information

Supported by the British Medical Association (Katherine Bishop Harman Award, 1996).

Read at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998.

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Varma, A., Gunn, J., Lindow, S.W. et al. Do routinely measured delivery variables predict anal sphincter outcome?. Dis Colon Rectum 42, 1261–1264 (1999). https://doi.org/10.1007/BF02234210

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  • DOI: https://doi.org/10.1007/BF02234210

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