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Zacchè MM, Ghosh J, Liapis I, Chilaka C, Latthe P, Toozs-Hobson P. Anal incontinence following obstetric anal sphincter injury: Is there a difference between subtypes? A systematic review. Neurourol Urodyn 2023; 42:1455-1469. [PMID: 37431160 DOI: 10.1002/nau.25235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/06/2023] [Accepted: 06/17/2023] [Indexed: 07/12/2023]
Abstract
AIMS Obstetric anal sphincter injury (OASI) is associated with long-term anal incontinence (AI). We aimed to address the following questions: (a) are women with major OASI (grade 3c and 4) at higher risk of developing AI when compared to women with minor OASI (grade 3a and 3b)? (b) is a fourth-degree tear more likely to cause AI over a third-degree tear? METHODS A systematic literature search from inception until September 2022. We considered prospective and retrospective cohort studies, cross-sectional and case-control studies without language restrictions. The quality was assessed by the Newcastle-Ottawa Scale and the Joanna Briggs Institute critical appraisal checklist. Risk ratios (RRs) were calculated to measure the effect of different grades of OASI. RESULTS Out of 22 studies, 8 were prospective cohort, 8 were retrospective cohort, and 6 were cross-sectional studies. Length of follow-up ranged from 1 month to 23 years, with the majority of the reports (n = 16) analysing data within 12-months postpartum. Third-degree tears evaluated were 6454 versus 764 fourth-degree tears. The risk of bias was low in 3, medium in 14 and high in 5 studies, respectively. Prospective studies showed that major tears are associated with a twofold risk of AI for major tears versus minor tears, while retrospective studies consistently showed a risk of fecal incontinence (FI) which was two- to fourfold higher. Prospective studies showed a trend toward worsening AI symptoms for fourth-degree tears, but this failed to reach statistical significance. Cross-sectional studies with long-term (≥5 years) follow-up showed that women with fourth-degree tear were more likely to develop AI, with an RR ranging from 1.4 to 2.2. Out of 3, 2 retrospective studies showed similar findings, but the follow-up was significantly shorter (≤1 year). Contrasting results were noted for FI rates, as only 5 out of 10 studies supported an association between fourth-degree tear and FI. CONCLUSIONS Most studies investigate bowel symptoms within few months from delivery. Data heterogeneity hindered a meaningful synthesis. Prospective cohort studies with adequate power and long-term follow-up should be performed to evaluate the risk of AI for each OASI subtype.
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Affiliation(s)
- Martino Maria Zacchè
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
| | - Jayasish Ghosh
- Department of Obstetrics and Gynaecology, Walsall Manor Hospital, Walsall, UK
| | - Ilias Liapis
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
| | - Chioma Chilaka
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
| | - Pallavi Latthe
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
| | - Philip Toozs-Hobson
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
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Which symptoms of pelvic floor dysfunction does physiotherapy improve after an OASI? Eur J Obstet Gynecol Reprod Biol 2021; 264:314-317. [PMID: 34364018 DOI: 10.1016/j.ejogrb.2021.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/25/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Obstetric Anal Sphincter Injury (OASI) is associated with significant morbidity in the form of pelvic floor dysfunction, both in the immediate period of healing and long term. The aim of this study was to determine the prevalence of urinary, anorectal and sexual symptoms arising from OASI within 6 weeks after delivery at their first physiotherapy appointment (immediate postnatal) and 3-6 months after delivery following completion of physiotherapy (intermediate postnatal). Symptom prevalence were compared between the two time periods and the impact of pelvic floor physiotherapy analysed to determine any changes in symptomology. STUDY DESIGN This prospective observational study, conducted at a tertiary teaching hospital, involved completion of a paper questionnaire by pelvic floor physiotherapists at the immediate postnatal review and by consultant gynaecologists at the intermediate postnatal review. Data were then compared to determine changes in symptoms using Fisher Exact tests and Mann Whitney U tests. RESULTS Of the 131 women seen within 6 weeks of delivery, follow-up data at 3-6 months were collected for 96. There was a significant improvement in pain on defecation (P = 0.008), rectal bleeding on wiping (P = 0.0233) and women's ability to defer a bowel motion (P = 0.0001) however faecal incontinence did not improve significantly even with supervised physiotherapy. Urinary symptoms including stress incontinence, urgency and nocturia also significantly improved at P = 0.0097, P = 0.0045 and P < 0.0001, respectively. For the sexual domain, significantly more women had resumed intercourse (P < 0.0001) and started using contraception (P < 0.0001) by the follow up appointment. CONCLUSION This study shows that physiotherapy is valuable in the treatment of urinary symptoms after delivery but does not have the same impact on faecal incontinence. Further investigation is required to confirm if early anal symptomology may be a predictor of long-term adverse outcomes.
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Bellussi F, Dietz HP. Postpartum ultrasound for the diagnosis of obstetrical anal sphincter injury. Am J Obstet Gynecol MFM 2021; 3:100421. [PMID: 34129995 DOI: 10.1016/j.ajogmf.2021.100421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 12/18/2022]
Abstract
This review presents the available data on the diagnosis of obstetrical anal sphincter injury by postnatal ultrasound imaging. There is increasing evidence that anal sphincter tears are often missed after childbirth and, even when diagnosed, often suboptimally repaired, with a high rate of residual defects after reconstruction. Even after postpartum diagnosis and primary repair, 25% to 50% of patients will have persistent anal incontinence. As clinical diagnosis may fail in the detection and classification of obstetrical anal sphincter injury, the use of imaging has been proposed to improve the detection and treatment of these lacerations. Notably, 3-dimensional endoanal ultrasound is considered the gold standard in the detection of obstetrical anal sphincter injury, and recently, 4-dimensional transperineal ultrasound, commonly available in obstetrical and gynecologic settings, has proven to be effective as well. Avoidance of forceps delivery when possible, performance of a rectal examination after vaginal delivery and before repair of any severe perineal tear, and offering sonographic follow-up at 10 to 12 weeks after vaginal delivery in high-risk women (maternal age of ≥35 years, vaginal birth after cesarean delivery, forceps, prolonged second stage of labor, overt obstetrical anal sphincter injury, shoulder dystocia, and macrosomia) may help reduce morbidity arising from anal sphincter tears.
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Affiliation(s)
- Federica Bellussi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA (Dr Bellussi).
| | - Hans Peter Dietz
- Department of Obstetrics, Gynecology, and Neonatology, Sydney Medical School Nepean, University of Sydney, Kingswood, New South Wales, Australia
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Schütze S, Hohlfeld B, Friedl TWP, Otto S, Kraft K, Hancke K, Hüner B, Janni W, Deniz M. Fishing for (in)continence: long-term follow-up of women with OASIS-still a taboo. Arch Gynecol Obstet 2020; 303:987-997. [PMID: 33258994 PMCID: PMC7985110 DOI: 10.1007/s00404-020-05878-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 11/04/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Obstetric anal sphincter injuries (OASIS) increase the risk for pelvic floor dysfunctions. The goal of this study was to examine the long-term outcomes after OASIS on pelvic floor functions and quality of life. MATERIAL AND METHODS Between 2005 and 2013, 424 women had an OASIS at the Women University Hospital Ulm. Out of these 71 women completed the German pelvic floor questionnaire, which includes questions regarding prolapse symptoms as well as bladder, bowel and sexual function. In addition, 64 women were physically examined, including a speculum examination to evaluate the degree of prolapse, a cough test to evaluate urinary stress incontinence (SI) and an evaluation of both pelvic floor sphincter (modified Oxford score) and anal sphincter contraction. RESULTS A high rate of pelvic floor disorders after OASIS was found, as 74.6% of women reported SI, 64.8% flatus incontinence and 18.3% stool incontinence, respectively. However, only few women stated a substantial negative impact on quality of life. The clinical examination showed that a positive cough test, a weak anal sphincter tone and a diagnosed prolapse correlated with the results of the self-reported questionnaire. CONCLUSION On one hand, OASIS has an influence on pelvic floor function going along with lots of complaints, while on the other hand, it still seems to be a taboo topic, as none of the participants spoke about the complaints after OASIS with a doctor. Therefore, the gynecologist should actively address these issues and offer therapy options for the women with persisting problems.
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Affiliation(s)
- Sabine Schütze
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Benedikt Hohlfeld
- Kbo-Lech-Mangfall Clinic Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Thomas W P Friedl
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Stephanie Otto
- Comprehensive Cancer Center Ulm (CCCU), Ulm University Hospital, Ulm, Germany
| | | | - Katharina Hancke
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Beate Hüner
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Miriam Deniz
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany.
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Abramowitz L, Mandelbrot L, Bourgeois Moine A, Tohic AL, Carne Carnavalet C, Poujade O, Roy C, Tubach F. Caesarean section in the second delivery to prevent anal incontinence after asymptomatic obstetric anal sphincter injury: the EPIC multicentre randomised trial. BJOG 2020; 128:685-693. [PMID: 32770616 DOI: 10.1111/1471-0528.16452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether planned caesarean section (CS) for a second delivery protects against anal incontinence in women with obstetric anal sphincter lesions. DESIGN Randomised trial. SETTING Six maternity units in the Paris area. SAMPLE Women at high risk of sphincter lesions (first delivery with third-degree laceration and/or forceps) but no symptomatic anal incontinence. METHODS Endoanal ultrasound was performed in the third trimester of the second pregnancy. Women with sphincter lesions were randomised to planned CS or vaginal delivery (VD). MAIN OUTCOME MEASURES Anal incontinence at 6 months postpartum. Secondary outcomes were urinary incontinence, sexual morbidity, maternal and neonatal morbidities and worsening of external sphincter lesions. RESULTS Anal sphincter lesions were detected by ultrasound in 264/434 women enrolled (60.8%); 112 were randomised to planned VD and 110 to planned CS. At 6-8 weeks after delivery, there was no significant difference in anal continence between the two groups. At 6 months after delivery, median Vaizey scores of anal incontinence were 1 (interquartile range 0-4) in the CS group and 1 (interquartile range 0-3) in the VD group (P = 0.34). There were no significant differences for urinary continence, sexual functions or for other maternal and neonatal morbidities. CONCLUSIONS In women with asymptomatic obstetric anal sphincter lesions diagnosed by ultrasound, planning a CS had no significant impact on anal continence 6 months after the second delivery. These results do not support advising systematic CS for this indication. TWEETABLE ABSTRACT Caesarean section for the second delivery did not protect against anal incontinence in women with asymptomatic obstetric anal sphincter lesions.
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Affiliation(s)
- L Abramowitz
- Hôpital Bichat, Proctology Unit, Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Ramsay général de santé, clinique Blomet, Paris, France
| | - L Mandelbrot
- Department of Obstetrics and Gynaecology, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.,Université de Paris, Paris, France.,Inserm IAME U1137, Paris, France
| | - A Bourgeois Moine
- Department of Obstetrics and Gynaecology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A L Tohic
- Department of Obstetrics and Gynaecology, Centre Hospitalier de Versailles, Le Chesnay, France
| | - C Carne Carnavalet
- Department of Obstetrics and Gynaecology, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - O Poujade
- Department of Obstetrics and Gynaecology Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Clichy, France.,Department of Obstetrics and Gynaecology, Hôpital des Rives de Seine, Neuilly, France
| | - C Roy
- Unité de Recherche Clinique, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM CIC-EC 1425, Paris, France
| | - F Tubach
- Département de Santé Publique, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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Hjorth S, Kirkegaard H, Olsen J, Thornton JG, Nohr EA. Mode of birth and long-term sexual health: a follow-up study of mothers in the Danish National Birth Cohort. BMJ Open 2019; 9:e029517. [PMID: 31685494 PMCID: PMC6858091 DOI: 10.1136/bmjopen-2019-029517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To investigate the relation between mode of birth and women's long-term sexual health. DESIGN Maternal follow-up of the Danish National Birth Cohort (1996-2002) in 2013-2014 including questions on sexual health. Logistic regression was used to relate registry-based information about mode of birth and perineal tears with data on sexual problems. SETTING Denmark. PARTICIPANTS Of 82 569 eligible mothers in the Danish National Birth Cohort, 43 639 (53%) completed the follow-up. Of these, 37 417 women had a partner, and answered at least one question on sexual health. MAIN OUTCOME MEASURES Self-reported sexual health. RESULTS Participants were on average 44 years old, and 16 years after their first birth. The frequency of sexual problems among women with only spontaneous vaginal births, the reference group, was 37%. For women who only had caesarean sections, more problems were reported (OR 1.18; 95% CI 1.09 to 1.28). For women who had a spontaneous vaginal birth subsequent to a caesarean, and for women with only vaginal births who had experienced one or more instrumental vaginal births, the odds of sexual problems did not differ from women with only spontaneous vaginal births (OR 1.00; 95% CI 0.91 to 1.11) and (OR 1.01; 95% CI 0.95 to 1.08), respectively. CONCLUSIONS These findings indicate that caesarean section does not protect against long-term sexual problems. Rather, vaginal birth, even after caesarean section, was associated with fewer long-term sexual problems.
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Affiliation(s)
- Sarah Hjorth
- Department of Clinical Research, Research Unit of Obstetrics and Gynecology, Syddansk Universitet, Odense, Denmark
| | - Helene Kirkegaard
- Department of Clinical Research, Research Unit of Obstetrics and Gynecology, Syddansk Universitet, Odense, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark
| | - Jim G Thornton
- Department of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | - Ellen A Nohr
- Department of Clinical Research, Research Unit of Obstetrics and Gynecology, Syddansk Universitet, Odense, Denmark
- Centre of Women's, Family and Child Health, University of South-Eastern Norway, Kongsberg, Norway
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What is the total impact of an obstetric anal sphincter injury? An Australian retrospective study. Int Urogynecol J 2019; 31:557-566. [PMID: 31529328 PMCID: PMC7093361 DOI: 10.1007/s00192-019-04108-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022]
Abstract
Introduction Most data on obstetric anal sphincter injury (OASI) reflect short-term (< 12 months) or much longer term (> 10 years) impact. This study aimed to collate the extent of medium-term symptomology (1–6 years) and observe the effect on future birth choices to evaluate the cumulative impact of OASI in affected women. Methods A retrospective cohort of women affected by OASI completed a questionnaire covering bowel symptomology, sexual function, life impact and future birth choices. A custom-created adverse composite outcome for OASI incorporating effects on daily life, flatal/fecal incontinence and sexual function (OASIACO) was used as a threshold score to identify women with high levels of symptoms. Results Of 265 eligible and contactable women, 210 questionnaires were received (response rate 79%) at a mean of 4 years post-OASI. More than half (54%) experienced an OASIACO. A forceps birth (p = 0.03) or more severe grade of tear (p = 0.03) was predictive of OASIACO. One hundred one women had further children, with 48% reporting their delivery choices were impacted, 32% electing a cesarean delivery and 26% shifting to private care. Eighty women (40%) had not given birth again, and 29 (36%) of these indicated their OASI influenced this decision. Conclusions The total impact of an OASI on women affected is substantial. More than half experience ongoing symptoms and close to half report an impact on their future birth choices. It follows there would be a consequential load on the healthcare sector, and improved management and prevention programs should be implemented. Electronic supplementary material The online version of this article (10.1007/s00192-019-04108-3) contains supplementary material, which is available to authorized users.
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Crookall R, Fowler G, Wood C, Slade P. A systematic mixed studies review of women's experiences of perineal trauma sustained during childbirth. J Adv Nurs 2018; 74:2038-2052. [PMID: 29791012 DOI: 10.1111/jan.13724] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/15/2018] [Indexed: 12/14/2022]
Abstract
AIM To explore the quantitative/qualitative literature on women's experiences of perineal trauma sustained during childbirth and the impact it may have on psychological/emotional wellbeing BACKGROUND: Obstetric complications during childbirth can be a risk factor for postpartum psychological distress. Perineal trauma is one of the most frequent obstetric complications and it is important to understand any impact on psychological/emotional wellbeing. DESIGN A convergent qualitative design using a hybrid deductive-inductive thematic synthesis approach to data transformation was used. DATA SOURCES Web of knowledge, CINAHL, MEDLINE, AMED, PsyArticles, PsycInfo until May 2017. REVIEW METHODS Stage 1: transforming findings from the qualitative, quantitative and mixed methods studies into themes using thematic synthesis. Stage 2: integrating themes from the quantitative studies into those derived from the qualitative studies RESULTS: Records (N=2152) found of which 11 qualitative 22 quantitative and 1 mixed methods were included in this review. Five themes were derived from thematic synthesis of qualitative studies 'The mystery of perineal trauma', 'The misery of perineal suturing', 'The postnatal perineum', 'Normalisation and feeling dismissed' and 'Adjusting to a new normal - Coping and compromise' and five themes identified from the quantitative studies, experience of birth (N=4), Sexual functioning (N=12), Social functioning (N=2), Psychological health (N=8) and Quality of Life (N=5). CONCLUSION Perineal trauma can have a negative impact on psychological/emotional wellbeing, however the literature is conflicted and in need of clarification. Future research should clearly describe the perineal status of the women in the sample, use validated measures and consider the timing of such measures. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Gillian Fowler
- Consultant Urogynaecologist, Liverpool Women's NHS Foundation Trust
| | - Caroline Wood
- Specialist Urogynaecological link midwife, Liverpool Women's NHS Foundation Trust
| | - Pauline Slade
- Clinical Psychology/Consultant Clinical Psychologist, University of Liverpool
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9
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[Anal incontinence and obstetrical anal sphincter injuries, epidemiology and prevention]. ACTA ACUST UNITED AC 2018; 46:419-426. [PMID: 29500142 DOI: 10.1016/j.gofs.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Indexed: 12/11/2022]
Abstract
Our main objectives were to identify risk factors, methods for early diagnosis, and prevention of obstetric anal sphincter injuries (OASIs), using a literature review. The main risk factors for OASIs are nulliparity, instrumental delivery, posterior presentation, median episiotomy, prolonged second phase of labor and fetal macrosomia. Asian origin, short ano-vulvar distance, ligamentous hyperlaxity, lack of expulsion control, non-visualization of the perineum or maneuvers for shoulder dystocia also appear to be risk factors. There is a risk of under-diagnosis of OASIs in the labor ward. Experience of the accoucheur is a protective factor. Secondary prevention is based on the training of birth professionals in recognition and repair of OASIs. Primary prevention of OASIs is based on training in the maneuvers of the second phase of labor; if possible, instrumental extractions should be avoided. Mediolateral episiotomy may have a preventive role in high-risk OASIs deliveries. A robust predictive model is still lacking to allow a selective use of episiotomy.
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10
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Linneberg S, Leenskjold S, Glavind K. A five year follow-up of women with obstetric anal sphincter rupture at their first delivery. Eur J Obstet Gynecol Reprod Biol 2016; 203:315-9. [DOI: 10.1016/j.ejogrb.2016.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/05/2016] [Accepted: 06/20/2016] [Indexed: 01/07/2023]
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11
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Evaluation of long-term pelvic floor symptoms after an obstetric anal sphincter injury (OASI) at least one year after delivery: A retrospective cohort study of 159 cases. ACTA ACUST UNITED AC 2016; 44:385-90. [DOI: 10.1016/j.gyobfe.2016.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/24/2016] [Indexed: 11/19/2022]
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12
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Sexual activity and dyspareunia the first year postpartum in relation to degree of perineal trauma. Int Urogynecol J 2016; 27:1513-23. [PMID: 27185318 DOI: 10.1007/s00192-016-3015-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/19/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Knowledge on sexual complaints and time to sexual resumption after obstetric anal sphincter injury (OASI) is scarce. The aim of the study was to investigate self-reported sexual activity and coital problems 1 year postpartum in relation to perineal trauma, in addition to delivery mode. METHODS Among 2,846 women recruited during pregnancy, all women who delivered with OASI (n = 42, all third-degree perineal tears), in addition to 20 randomly selected controls per OASI case, a total of 882 women, were sent a self-administered questionnaire addressing time to coital resumption after delivery and potential coital difficulty 1 year postpartum. RESULTS By 8 weeks, half of the 561 responders (51.4 %) had resumed intercourse, increasing to 75.2 % by 12 weeks and 94.7 % 1 year postpartum. In multivariate regression analysis OASI was the strongest predictor for postponed coital onset, defined as after 8 weeks (aOR 5.52, CI 1.59-19.16). OASI was also the only significant predictor for dyspareunia 1 year after delivery (aOR 3.57, CI 1.39-9.19). Episiotomy was neither a risk factor for postponed coital onset nor for dyspareunia. There were no differences between episiotomy and second-degree laceration injury groups regarding postponed coital onset (p = 0.45) or dyspareunia (p = 0.67) 1 year postpartum. CONCLUSIONS Obstetric anal sphincter injury was a strong and independent predictor for both postponed coital resumption after delivery and for dyspareunia 1 year postpartum, whereas episiotomy and spontaneous second-degree lacerations were not. Our main finding of affected sexual activity after OASI further supports the need to reduce the rates of this obstetric injury to a minimum.
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13
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Andreucci CB, Bussadori JC, Pacagnella RC, Chou D, Filippi V, Say L, Cecatti JG. Sexual life and dysfunction after maternal morbidity: a systematic review. BMC Pregnancy Childbirth 2015; 15:307. [PMID: 26596506 PMCID: PMC4657322 DOI: 10.1186/s12884-015-0742-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/17/2015] [Indexed: 12/13/2022] Open
Abstract
Background Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women´s sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth. Methods Systematic review on aspects of women sexual life after any maternal morbidity and/or maternal near miss, during different time periods after delivery. The search was carried out until May 22nd, 2015 including studies published from 1995 to 2015. No language or study design restrictions were applied. Maternal morbidity as exposure was split into general or severe/near miss. Female sexual outcomes evaluated were dyspareunia, Female Sexual Function Index (FSFI) scores and time to resume sexual activity after childbirth. Qualitative syntheses for outcomes were provided whenever possible. Results A total of 2,573 studies were initially identified, and 14 were included for analysis after standard selection procedures for systematic review. General morbidity was mainly related to major perineal injury (3rd or 4th degree laceration, 12 studies). A clear pattern for severity evaluation of maternal morbidity could not be distinguished, unless when a maternal near miss concept was used. Women experiencing maternal morbidity had more frequently dyspareunia and resumed sexual activity later, when compared to women without morbidity. There were no differences in FSFI scores between groups. Meta-analysis could not be performed, since included studies were too heterogeneous regarding study design, evaluation of exposure and/or outcome and time span. Conclusion Investigation of long-term repercussions on women’s sexual life aspects after maternal morbidity has been scarcely performed, however indicating worse outcomes for those experiencing morbidity. Further standardized evaluation of these conditions among maternal morbidity survivors may provide relevant information for clinical follow-up and reproductive planning for women.
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Affiliation(s)
- Carla B Andreucci
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil. .,Federal University of Sao Carlos, Sao Carlos, Brazil.
| | | | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
| | - Doris Chou
- Reproductive Health Research unit, World Health Organization, Geneva, Switzerland.
| | - Veronique Filippi
- London School of Hygiene and Tropical Medicine, University of London, London, England, UK.
| | - Lale Say
- Reproductive Health Research unit, World Health Organization, Geneva, Switzerland.
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
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14
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Pizzoferrato AC, Samie M, Rousseau A, Rozenberg P, Fauconnier A, Bader G. [Severe post-obstetric perineal tears: Medium-term consequences on women's quality of life]. Prog Urol 2015; 25:530-5. [PMID: 26032455 DOI: 10.1016/j.purol.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/31/2015] [Accepted: 04/14/2015] [Indexed: 12/15/2022]
Abstract
AIMS To assess the prevalence of anal (AI) and urinary (UI) incontinence at medium term after 3rd and 4th degree anal sphincter tears and their impact on sexuality and women's quality of life. MATERIAL It is a case-control, single center study. Sixty-eight primiparous women delivered with severe anal sphincter tear (exposed group) were compared to 136 women without (control group). Questionnaires on anal and urinary incontinence, sexual function and quality of life, using validated scores, were sent between two and five years after the first delivery. Maternal and obstetric data were collected retrospectively on the medical files. RESULTS The answer rate was 22.5% (46/204) of which 30.9% (21/68) in the exposed group and 18.4% (25/136) in the unexposed group. In case of severe anal sphincter tear, 57.1% of women reported an AI vs 48% in the control group (P=0.76). The rate of AI for liquid stool was significantly higher in the exposed group (P=0.05). Patients with severe perineal tears reported a greater impact of symptoms on their quality of life but the difference with the control group was not significant. CONCLUSIONS The severity of symptoms related to anal sphincter tears is common and underestimated. Preventive measures must be improved in order to maintain women's quality of life. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A-C Pizzoferrato
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France.
| | - M Samie
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France
| | - A Rousseau
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France
| | - P Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France
| | - A Fauconnier
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France
| | - G Bader
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France
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Abstract
OBJECTIVE To examine relationships among parity, mode of delivery, and other parturition-related factors with women's sexual function later in life. METHODS Self-administered questionnaires examined sexual desire, activity, satisfaction, and problems in a multiethnic cohort of women aged 40 years and older with at least one past childbirth event. Trained abstractors obtained information on parity, mode of delivery, and other parturition-related factors from archived records. Multivariable regression models examined associations with sexual function controlling for age, race or ethnicity, partner status, diabetes, and general health. RESULTS Among 1,094 participants, mean (standard deviation) age was 56.3 (±8.7) years, 568 (43%) were racial or ethnic minorities (214 African American, 171 Asian, and 183 Latina), and 963 (88%) were multiparous. Fifty-six percent (n=601) reported low sexual desire; 53% (n=577) reported less than monthly sexual activity, and 43% (n=399) reported low overall sexual satisfaction. Greater parity was not associated with increased risk of reporting low sexual desire (adjusted odds ratio [OR] 1.08, confidence interval [CI] 0.96-1.21 per each birth), less than monthly sexual activity (adjusted OR 1.05, CI 0.93-1.20 per each birth), or low sexual satisfaction (adjusted OR 0.96, CI 0.85-1.09 per each birth). Compared with vaginal delivery alone, women with a history of cesarean delivery were not significantly more likely to report low desire (adjusted OR 0.71, CI 0.34-1.47), less than monthly sexual activity (adjusted OR 1.03, CI 0.46-2.32), or low sexual satisfaction (adjusted OR 0.57, CI 0.26-1.22). Women with a history of operative-assisted delivery were more likely to report low desire (adjusted OR 1.38, CI 1.04-1.83). CONCLUSIONS Among women with at least one childbirth event, parity and mode of delivery are not major determinants of sexual desire, activity, or satisfaction later in life. LEVEL OF EVIDENCE II.
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Visscher AP, Lam TJ, Hart N, Felt-Bersma RJF. Fecal incontinence, sexual complaints, and anorectal function after third-degree obstetric anal sphincter injury (OASI): 5-year follow-up. Int Urogynecol J 2013; 25:607-13. [DOI: 10.1007/s00192-013-2238-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/20/2013] [Indexed: 11/28/2022]
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17
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Wesnes SL, Lose G. Preventing urinary incontinence during pregnancy and postpartum: a review. Int Urogynecol J 2013; 24:889-99. [DOI: 10.1007/s00192-012-2017-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 12/01/2012] [Indexed: 11/30/2022]
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18
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Anal and urinary incontinence 4 years after a vaginal delivery. Int Urogynecol J 2012; 24:55-60. [DOI: 10.1007/s00192-012-1835-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/20/2012] [Indexed: 02/08/2023]
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19
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Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery. Int Urogynecol J 2011; 22:1127-34. [PMID: 21512827 DOI: 10.1007/s00192-011-1431-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 04/04/2011] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study aims to estimate fecal, urinary incontinence, and sexual function 6 years after an obstetrical anal sphincter tear. METHODS Among 13,213 women who had a vaginal delivery of a cephalic singleton at term, 196 women sustained an anal sphincter tear. They were matched to 588 controls. Validated questionnaires grading fecal and urinary incontinence, and sexual dysfunction were completed by the participants. RESULTS Severe fecal incontinence was more frequently reported by women who had sustained an anal sphincter tear compared to the controls. Women with an anal sphincter tear had no increased risk of urinary incontinence, but reported significantly more pain, difficulty with vaginal lubrication, and difficulty achieving orgasm compared to the controls. A fetal occiput posterior position during childbirth was an independent risk factor for both severe urinary incontinence and severe sexual dysfunction. CONCLUSIONS Fecal incontinence is strongly associated with an anal sphincter tear. A fetal occiput posterior position represents a risk factor for urinary incontinence and sexual dysfunction.
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Fritel X. Périnée et grossesse. ACTA ACUST UNITED AC 2010; 38:332-46. [DOI: 10.1016/j.gyobfe.2010.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 03/16/2010] [Indexed: 01/26/2023]
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21
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Sexual function following anal sphincteroplasty for fecal incontinence. Am J Obstet Gynecol 2007; 197:618.e1-6. [PMID: 18060952 DOI: 10.1016/j.ajog.2007.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 04/16/2007] [Accepted: 08/06/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of the study was to assess sexual function following anal sphincteroplasty and determine associations between sexual function and fecal incontinence. STUDY DESIGN Women 1 year or longer following anal sphincteroplasty with or without other reconstructive surgery were matched to controls. Subjects were mailed the Female Sexual Function Index (FSFI), Fecal Incontinence Quality of Life (FIQOL), Fecal Incontinence Severity Index (FISI), and a general questionnaire. RESULTS Twenty-six cases and 26 controls responded; 73% were sexually active. Sexual function scores were similar between the groups. Seventeen sphincteroplasty patients and 8 controls complained of fecal incontinence at follow up. Significant correlations were found between FSFI domains and the FIQOL depression/self-perception scale, FISI fecal incontinence of solid stool, and total FISI. CONCLUSION Sexual activity and function was similar following anal sphincteroplasty, compared with controls, despite worse symptoms of fecal incontinence. Fecal incontinence of solid stool and depression related to fecal incontinence were correlated with poorer sexual function.
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Mous M, Muller SA, De Leeuw JW. Long-term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints. BJOG 2007; 115:234-8. [DOI: 10.1111/j.1471-0528.2007.01502.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Scheer I, Andrews V, Thakar R, Sultan AH. Urinary incontinence after obstetric anal sphincter injuries (OASIS)—is there a relationship? Int Urogynecol J 2007; 19:179-83. [PMID: 17671753 DOI: 10.1007/s00192-007-0431-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 07/05/2007] [Indexed: 11/26/2022]
Abstract
This study aimed to compare urinary symptoms and its impact on women's quality of life after obstetric anal sphincter injuries (OASIS) with a matched control group in the short term. The study group consisted of 100 primiparous women with OASIS and 104 controls who sustained a second-degree tear or had a mediolateral episiotomy performed. All women completed a validated International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire 10 weeks after delivery. Compared to controls, significantly more women with OASIS reported overall urinary incontinence (21.2 vs 38%, p = 0.005) and had significantly worse quality of life score (incontinence score: 2.42 vs 1.2; p = 0.008). Significantly more women with OASIS suffered from stress urinary incontinence (33 vs 14%; p = 0.002; OR 3.06; CI = 1.54-6.07) than controls. Logistic regression analysis revealed that OASIS and a prolonged (>50 min) second stage of labour were independent risk factors for the development of stress urinary incontinence. This study highlights the importance of inquiring about urinary incontinence in women with OASIS.
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Affiliation(s)
- Inka Scheer
- Urogynaecology Unit, Mayday University Hospital, 530, London Road, Croydon, CR7 7YE, UK
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24
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Goldberg J. The effect of exposure misclassification in a long-term study of women's health 18 years after rupture of the anal sphincter during childbirth. Am J Obstet Gynecol 2007; 196:e10; author reply e10-1. [PMID: 17141169 DOI: 10.1016/j.ajog.2006.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 08/16/2006] [Indexed: 11/21/2022]
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25
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Faltin DL, Boulvain M, Irion O. Reply. Am J Obstet Gynecol 2007. [DOI: 10.1016/j.ajog.2006.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Current World Literature. Curr Opin Obstet Gynecol 2006. [DOI: 10.1097/01.gco.0000242963.55738.b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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