Deterioration of anal sphincter function following second vaginal delivery in women withprevious intrapartum perineal tears: LTP38


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Abstract

Aim:To determine whether women withprevious third/fourth degree perineal tears develop worsening anal sphincter function following a subsequent vaginal delivery. Endoanal Ultrasound (EAUS) and Anorectal Physiology (ARP) are offered as part of counselling the mode of subsequent delivery in women withprevious perineal tears [1,2].Method:Between November 2001 and November 2009, 303 women with third/fourth degree perineal tears underwent EAUS/ARP investigation. Forty-three opted for a subsequent vaginal delivery and were offered a repeat EAUS/ARP. Fifteen women attended for investigation.Results:Eleven out of 15 (73%) demonstrated deterioration in the repeat EAUS/ARP results in comparison to the initial investigation. Eight developed a new external anal sphincter defect, three developed a new internal anal sphincter defect plus low ARPpressures, and four developed abnormally low ARPpressures. Only three became symptomatic, one experiencing faecal urgency and two developing flatal incontinence.Conclusion:The results show that vaginal delivery after aprevious third/fourth degree perineal tear is associated with deterioration in anal function demonstrated by EAUS/ARP studies. This could be due to thepresence of anal sphincter damage from the initial trauma rather than a new tear, with original 3b/3c tears more likely to cause EAUS/ARP deterioration.

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