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Effect of vaginal delivery on endosonographic anal sphincter morphology

Starck-Söndergaard, Marianne LU ; Bohe, Måns LU and Valentin, Lil LU (2007) In European Journal of Obstetrics, Gynecology, and Reproductive Biology 130(2). p.193-201
Abstract
Objective



To describe the effect of vaginal delivery with no clinically recognized sphincter tear on endosonographic anal sphincter morphology and sphincter pressure and to relate endosonographic results to anal sphincter pressure and anal incontinence score.



Study design



Thirty-two nullipara underwent anal endosonography and anal manometry in the third trimester of pregnancy, 2 weeks and 6 months post-partum. The sphincter defect scores (1–16) and the thickness and length of the sphincters were measured by endosonography, and sphincter pressures and manometric sphincter lengths were determined. The Wexner incontinence score (1–20) was used to classify anal incontinence 6 months... (More)
Objective



To describe the effect of vaginal delivery with no clinically recognized sphincter tear on endosonographic anal sphincter morphology and sphincter pressure and to relate endosonographic results to anal sphincter pressure and anal incontinence score.



Study design



Thirty-two nullipara underwent anal endosonography and anal manometry in the third trimester of pregnancy, 2 weeks and 6 months post-partum. The sphincter defect scores (1–16) and the thickness and length of the sphincters were measured by endosonography, and sphincter pressures and manometric sphincter lengths were determined. The Wexner incontinence score (1–20) was used to classify anal incontinence 6 months post-partum.



Results



Five (16%) women had small endosonographic anal sphincter defects (score 3–4) before delivery. Eight women (25%; confidence interval 11–43%) had new defects detected post-partum, five small, one moderate (score 7), and two large (score 10–11). Six (75%) of eight women with new defects post-partum had undergone episiotomy versus five (21%) of 24 women with no new defects (p = 0.02). Six months after delivery 16 (50%) women reported anal incontinence, and there was a positive correlation between the endosonographic defect score 6 months post-partum and the Wexner incontinence score. The sphincter was significantly longer during pregnancy than 6 months post-partum.



Conclusion



New sphincter defects may arise after vaginal delivery without any clinically recognizable sphincter tear. There is a positive correlation between the endosonographic defect score 6 months post-partum and the Wexner incontinence score. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Vaginal delivery, Ultrasonography, Anal sphincter defects, Anal incontinence
in
European Journal of Obstetrics, Gynecology, and Reproductive Biology
volume
130
issue
2
pages
193 - 201
publisher
Elsevier
external identifiers
  • wos:000244283600009
  • scopus:33846185127
ISSN
0301-2115
DOI
10.1016/j.ejogrb.2006.04.009
language
English
LU publication?
yes
id
ce5f5e44-4b88-4e0b-887e-ef77f2361f24 (old id 156659)
date added to LUP
2007-07-30 09:54:03
date last changed
2017-06-11 03:27:33
@article{ce5f5e44-4b88-4e0b-887e-ef77f2361f24,
  abstract     = {Objective<br/><br>
<br/><br>
To describe the effect of vaginal delivery with no clinically recognized sphincter tear on endosonographic anal sphincter morphology and sphincter pressure and to relate endosonographic results to anal sphincter pressure and anal incontinence score.<br/><br>
<br/><br>
Study design<br/><br>
<br/><br>
Thirty-two nullipara underwent anal endosonography and anal manometry in the third trimester of pregnancy, 2 weeks and 6 months post-partum. The sphincter defect scores (1–16) and the thickness and length of the sphincters were measured by endosonography, and sphincter pressures and manometric sphincter lengths were determined. The Wexner incontinence score (1–20) was used to classify anal incontinence 6 months post-partum.<br/><br>
<br/><br>
Results<br/><br>
<br/><br>
Five (16%) women had small endosonographic anal sphincter defects (score 3–4) before delivery. Eight women (25%; confidence interval 11–43%) had new defects detected post-partum, five small, one moderate (score 7), and two large (score 10–11). Six (75%) of eight women with new defects post-partum had undergone episiotomy versus five (21%) of 24 women with no new defects (p = 0.02). Six months after delivery 16 (50%) women reported anal incontinence, and there was a positive correlation between the endosonographic defect score 6 months post-partum and the Wexner incontinence score. The sphincter was significantly longer during pregnancy than 6 months post-partum.<br/><br>
<br/><br>
Conclusion<br/><br>
<br/><br>
New sphincter defects may arise after vaginal delivery without any clinically recognizable sphincter tear. There is a positive correlation between the endosonographic defect score 6 months post-partum and the Wexner incontinence score.},
  author       = {Starck-Söndergaard, Marianne and Bohe, Måns and Valentin, Lil},
  issn         = {0301-2115},
  keyword      = {Vaginal delivery,Ultrasonography,Anal sphincter defects,Anal incontinence},
  language     = {eng},
  number       = {2},
  pages        = {193--201},
  publisher    = {Elsevier},
  series       = {European Journal of Obstetrics, Gynecology, and Reproductive Biology},
  title        = {Effect of vaginal delivery on endosonographic anal sphincter morphology},
  url          = {http://dx.doi.org/10.1016/j.ejogrb.2006.04.009},
  volume       = {130},
  year         = {2007},
}