Perineal rupture following vaginal delivery. Long-term consequences.

Twenty-five women with complete perineal rupture were compared with a control group of 25 women, with regard to risk factors and possible long-term sequelae as a consequence of perineal damage. Following an average period of 78 months (52-123), all women received a questionnaire and were invited to a clinical follow-up, which included perineal inspection and measurement of the anal pressure profile. Vacuum extraction was more frequent in the rupture group than among controls (p less than 0.002). Eighty percent of the women in the rupture group were primiparae, compared with an overall rate of 40% (p less than 0.02). Forty-two percent of the women in the rupture group reported anal incontinence, compared with none in the control group (p less than 0.01). Most of these women reported stress-provoked incontinence regarding flatus and loose stools. Measurement of the anal pressure profile showed markedly reduced sphincter pressure, with maximum squeeze in the rupture group, but no differences were found regarding maximum anal pressure at rest. Sphincter length was reduced both at rest and with maximal squeeze in the rupture group. It is concluded that complete perineal rupture is a condition with possible long-term consequences such as reduced sphincter strength and partial anal incontinence.