Anal sphincter injury after forceps delivery in primiparous females : endosonocraphic detection and Surgical management

الملخص EN

Objective : This study was designed to estimate the prevalence, detection, and treatment of anal sphincter injury after forceps delivery in primiparous females managed by trained obstetrician to identify factors predictive for this injury.

Method : We performed a prospective study of healthy females with no history of anal incontinence, anorectal abnormalities, or anorectal surgery after their first vaginal delivery.

All females were interviewed using a standardized questionnaire concerning intestinal transit and continence status.

Physical examination and endoanal ultrasonography were performed after delivery.

Results : 46 females were included in the study after their first forceps delivery.

Eleven patients (23 %) had flatus incontinence, and three patients (6 %) had liquid stool incontinence.

Nine patients (19 %) had variable degrees of fecal incontinence with edosonographically detected sphincteric defects.

Seven of these 9 patients (15 %) had a partial defect involving the external sphincter and the other two patients (4 %) had a partial defect of external sphincter with defects of internal sphincter (squeal of primary repair of a third degree perineal tears).

Overlap sphincteroplasty was done to 10 patients (22 %) with good results in eight (80 %) and poor results in two (20 %) patients.

A high daily number of stools was significantly associated with sphincter defect visible on ultrasonography (P = < 0.02).

The development of anal incontinence was related to sphincter defect on ultrasonography there was a strong association between perineal tear and sphincter defect visible on ultrasonography.

Conclusion : Anal sphincter injury after forceps delivery was identified in 19 % percent of our previously healthy females.

Our study confirms previous observations that anal sphincter injury is common after forceps delivery.

The only factor with significant predictive value for anal sphincter injury was perineal tear.

Overlap sphincteroplasty gives a good result with the properly detected sphincter injury.

Anal endosonography should be recommended after any obstetric perineal tears.