Anal sphincter: prior lacerations don't affect recurrence risk.
The study confirms earlier findings that operative vaginal delivery with episiotomy increases the risk of recurrent lacerations by two- to threefold, and forceps delivery is associated with higher occurrence of anal sphincter injury, compared with vacuum delivery.
In what she said is the largest study of its kind to examine the rate of recurrence of anal sphincter laceration, Dr. Dandolu and her associates analyzed data from the Pennsylvania state inpatient database concerning cases of third- and fourth-degree perineal lacerations that occurred between January 1990 and December 1991.
The 74,881 cesarean section deliveries that occurred during the study period were excluded from the analysis. Of the remaining 258,507 deliveries tracked in the study, 18,888 were cases of third- and fourth-degree lacerations, said Dr. Dandolu of the division of urogynecology at Temple University Hospital, Philadelphia.
There were 19,989 forceps deliveries, 22,110 vacuum deliveries, and 132,076 episiotomies. The rate of anal sphincter laceration was 15% with forceps delivery, 21% with forceps and episiotomy, 9% with vacuum-assisted vaginal delivery, and 16% when vacuum was used with episiotomy. Episiotomy in the absence of instrumental delivery did not increase the risk of anal sphincter laceration.
Over the next 10 years there were 14,990 subsequent vaginal deliveries in the women with prior lacerations. Among these, third- or fourth-degree laceration recurred in only 854 (6%).
Compared with spontaneous vaginal delivery, instrumental vaginal delivery was associated with significantly increased risk of recurrent lacerations, with odds ratios of 3.84 for forceps delivery, 3.89 for forceps delivery with episiotomy, 2.58 for vacuum delivery, and 2.93 for vacuum delivery with episiotomy. Prior anal sphincter laceration was not a significant risk factor for recurrence.
BY DOUG BRUNK
San Diego Bureau
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|Publication:||OB GYN News|
|Date:||Sep 15, 2004|
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