Abstract
Objective: Analysis of women undergoing vaginal birth with 3rd or 4th degree perineal tears. Type of study: Review and analysis of the data from our department.
Setting: Department of Gynecology and Obstetrics, 1st Medical Faculty of Charles University and Hospital Na Bulovce, Prague. Introduction: Obstetric anal sphincter injuries (OASIS) belong to dreaded complications after vaginal delivery.
The injury is associated with significant maternal morbidity. The most common difficulties are perineal pain, dyspareunia, flatulence and anal incontinence.
OASIS are main cause of anal incontinence in women. Main results: During monitored period 2015-2017 we performed 6185 childbirths in our ward.
Cesarean section was performed at 21% of births, instrumental vaginal birth at 5,7% and 73,3% of women had a spontaneous vaginal birth. Our analysis included 4888 births.
In our group 92,8% of women gave birth spontaneously regardless of injury and at 7,2% we performed an instrumental delivery. Perineal tears of 3rd and 4th degree were detected in 1,7% (83/4888) of vaginal births independent of vaginal ending. 85,5% were nulliparous women.
In a group of instrumental deliveries the risk of OASI was higher. We have detected injury at 5,4% (19/352) of this type of delivery.
The most detected perineal trauma in 47% was injury involving more than 50% of external anal sphincter thickness torn (3b). Surprising was a high incidence of mediolateral episiotomy in a group of women who sustained OASI.
The most frequent symptoms three months after birth were flatus incontinence and dyspareunia. Conclusion: Obstetric anal sphincter injury is associated with significant maternal morbidity.
The most serious consequence is an anal incontinence. With other symptoms as a dyspareunia and a perineal pain it leads to psychosocial problems.
Thorough treatment reduces the risk of complications.