The impact of forceps and vacuum assisted vaginal delivery on anal sphincter function

الملخص EN

Aim : To assess anal sphincter function following forceps and vacuum assisted vaginal delivery. Patients and Methods : The study included 64 primiparous women with indicated instrumental delivery.

The women included in the study were randomized to either a vacuum or low forceps assisted vaginal delivery.

Follow up consisted of clinical evaluation, anal manometry and endoanal ultrasound at three months post-partum. Results : 30 women delivered with forceps and 34 with vacuum assistance.

There were no statistical differences in the antecedent antenatal factors between both groups.

A third degree perineal tear followed 5 (17 %) forceps and 2 (6 %) vacuum deliveries.

18 (60 %) women complained of altered faecal continence after forceps delivery compared with 11 (32 %) following vacuum delivery , three months post-partum (RR 2.73, 95 % CI 1.39-5.77).

Endoanal ultrasound was reported as abnormal following 16 (53 %) forceps deliveries and 15(44 %) vacuum deliveries (RR 1.2, 95 % CI 0.64-2.61).

Median anal canal resting pressure was significantly lower following forceps delivery compared with vacuum delivery.

There were no significant differences in degree of ultrasound abnormality between the two groups. Conclusions : Based on continence outcome, vacuum should be preferred than forceps in assisted delivery as symptoms of altered foecal continence are significantly more common following forceps delivery.