Abstract
Objective
To describe the effect of vaginal delivery with no clinically recognized sphincter tear on endosonographic anal sphincter morphology and sphincter pressure and to relate endosonographic results to anal sphincter pressure and anal incontinence score.
Study design
Thirty-two nullipara underwent anal endosonography and anal manometry in the third trimester of pregnancy, 2 weeks and 6 months post-partum. The sphincter defect scores (1–16) and the thickness and length of the sphincters were measured by endosonography, and sphincter pressures and manometric sphincter lengths were determined. The Wexner incontinence score (1–20) was used to classify anal incontinence 6 months post-partum.
Results
Five (16%) women had small endosonographic anal sphincter defects (score 3–4) before delivery. Eight women (25%; confidence interval 11–43%) had new defects detected post-partum, five small, one moderate (score 7), and two large (score 10–11). Six (75%) of eight women with new defects post-partum had undergone episiotomy versus five (21%) of 24 women with no new defects (p = 0.02). Six months after delivery 16 (50%) women reported anal incontinence, and there was a positive correlation between the endosonographic defect score 6 months post-partum and the Wexner incontinence score. The sphincter was significantly longer during pregnancy than 6 months post-partum.
Conclusion
New sphincter defects may arise after vaginal delivery without any clinically recognizable sphincter tear. There is a positive correlation between the endosonographic defect score 6 months post-partum and the Wexner incontinence score.
To describe the effect of vaginal delivery with no clinically recognized sphincter tear on endosonographic anal sphincter morphology and sphincter pressure and to relate endosonographic results to anal sphincter pressure and anal incontinence score.
Study design
Thirty-two nullipara underwent anal endosonography and anal manometry in the third trimester of pregnancy, 2 weeks and 6 months post-partum. The sphincter defect scores (1–16) and the thickness and length of the sphincters were measured by endosonography, and sphincter pressures and manometric sphincter lengths were determined. The Wexner incontinence score (1–20) was used to classify anal incontinence 6 months post-partum.
Results
Five (16%) women had small endosonographic anal sphincter defects (score 3–4) before delivery. Eight women (25%; confidence interval 11–43%) had new defects detected post-partum, five small, one moderate (score 7), and two large (score 10–11). Six (75%) of eight women with new defects post-partum had undergone episiotomy versus five (21%) of 24 women with no new defects (p = 0.02). Six months after delivery 16 (50%) women reported anal incontinence, and there was a positive correlation between the endosonographic defect score 6 months post-partum and the Wexner incontinence score. The sphincter was significantly longer during pregnancy than 6 months post-partum.
Conclusion
New sphincter defects may arise after vaginal delivery without any clinically recognizable sphincter tear. There is a positive correlation between the endosonographic defect score 6 months post-partum and the Wexner incontinence score.
| Original language | English |
|---|---|
| Pages (from-to) | 193-201 |
| Journal | European Journal of Obstetrics, Gynecology, and Reproductive Biology |
| Volume | 130 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 2007 |
Bibliographical note
The information about affiliations in this record was updated in December 2015.The record was previously connected to the following departments: Emergency medicine/Medicine/Surgery (013240200), Obstetrics and Gynaecology (013242700), Obstetric, Gynaecological and Prenatal Ultrasound Research Unit (013242720), Surgery Research Unit (013242220)
Subject classification (UKÄ)
- Gynaecology, Obstetrics and Reproductive Medicine
Free keywords
- Vaginal delivery
- Ultrasonography
- Anal sphincter defects
- Anal incontinence