Recognition and management of obstetric anal sphincter injuries
DOI:
https://doi.org/10.6016/ZdravVestn.3329Keywords:
epidemiology, obstetric anal sphincter injuries, primary surgical repair, risk factors, third and fourth degree perineal tearsAbstract
More than 85% of women experience some degree of perineal trauma during vaginal delivery, and obstetric anal sphincter injuries occur in 0.5-7% of all vaginal deliveries. Up to 20-40% of obstetric anal sphincter injuries are either occult or missed, so it is of uttermost importance to recognize them properly. In case of obstetric anal sphincter injury, it is advisable to perform the repair in the surgical theatre. Before repair, it is necessary to examine the tear under adequate lighting and analgesia. Anorectal mucosa is sutured with either interrupted or continuous sutures, while the internal anal sphincter can be sutured with either interrupted or mattress sutures. For injuries of the external anal sphincter involving the full length and thickness of the muscle, either the end-to-end suture technique or the overlap technique can be used, or the end-to-end technique for partial injuries. In the end, perineal muscles and skin are sutured. Antibiotic prophylaxis and laxatives are used in the perioperative period. Patient follow-up is required for the first time in 6-12 weeks after delivery. Among the most common consequences of obstetric anal sphincter injuries are perineal pain and dyspareunia, negative impact on sexual life, and anal incontinence, which occurs in 15-61% of all cases. Women also need to be counselled regarding the mode of delivery in the subsequent pregnancy, as a risk for another obstetric anal sphincter injury in the subsequent delivery is 4-8%.
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