Open AccessObstetric anal sphincter injury and incontinence 15–23 years after vaginal delivery
Author(s) -
Halle Tuva K.,
Salvesen Kjell Å.,
Volløyhaug Ingrid
Publication year - 2016
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12898
Subject(s) - medicine , vaginal delivery , odds ratio , anal sphincter , gynecology , obstetrics , forceps delivery , fecal incontinence , pregnancy , surgery , genetics , biology
The primary aim was to study prevalence of obstetric anal sphincter injuries ( OASIS ) after normal vaginal deliveries ( NVD ) and operative vaginal deliveries ( OVD ) with a subgroup analysis of forceps ( FD ) vs. vacuum deliveries ( VD ). The secondary aim was to study the association between OASIS and anal incontinence 15–23 years later. Material and methods This was a cross‐sectional study including 8137 primiparous women in Trondheim, Norway, from 1990 to 1997. The outcome measure was the adjusted odds ratio ( aOR ) for OASIS between delivery groups. A total of 1122 women responded to a postal questionnaire containing the Colorectal‐Anal Distress Inventory ( CRADI ) in 2013. The aOR for anal incontinence and the difference in CRADI score between women with and without OASIS were calculated. Results OASIS prevalence was 2% for NVD and 10% for OVD (10% FD , 9% VD ). aOR for OASIS was 5.01 (95% CI 3.85–6.51) comparing OVD with NVD . There was no difference between FD and VD ( aOR 1.15, 95% CI 0.79–1.67). FD was associated with higher risk of fourth degree perineal tear than VD ( aOR 5.08, 95% CI 1.47–17.49). OASIS was associated with increased risk of leakage of well‐formed ( aOR 8.61, 95% CI 3.08–24.12) and loose stool ( aOR 2.75, 95% CI 1.43–5.27) and higher CRADI score (Mann–Whitney U ‐test, p = 0.01). Conclusions OVD was associated with increased risk of OASIS . FD was associated with higher risk of fourth degree perineal tear compared with VD . OASIS was associated with increased risk of anal incontinence and higher CRADI score 15–23 years later.