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.
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.
Authors: T Aigmueller; W Bader; K Beilecke; K Elenskaia; A Frudinger; E Hanzal; H Helmer; H Huemer; M van der Kleyn; D Koelle; S Kropshofer; J Pfeiffer; C Reisenauer; A Tammaa; K Tamussino; W Umek Journal: Geburtshilfe Frauenheilkd Date: 2015-02 Impact factor: 2.915
Authors: T Aigmueller; W Umek; K Elenskaia; A Frudinger; J Pfeifer; H Helmer; H Huemer; A Tammaa; M van der Kleyn; K Tamussino; D Koelle Journal: Int Urogynecol J Date: 2012-11-17 Impact factor: 2.894
Authors: E J Geller; B L Robinson; C A Matthews; K P Celauro; G C Dunivan; A K Crane; A R Ivins; P C Woodham; J R Fielding Journal: Int Urogynecol J Date: 2013-12-12 Impact factor: 2.894