Risk factors for sonographic internal anal sphincter gaps 6-12 months after delivery complicated by anal sphincter tear

• Published in: American journal of obstetrics and gynecology Vol. 197; no. 3; pp. 310.e1 - 310.e5
• Main Authors: Bradley, Catherine S., MD, MSCE, Richter, Holly E., PhD, MD, Gutman, Robert E., MD, Brown, Morton B., PhD, Whitehead, William E., PhD, Fine, Paul M., MD, Hakim, Christiane, MD, Harford, Frank, MD, Weber, Anne M., MD, MS
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.09.2007; Elsevier
• Subjects: Adult; Anal Canal - diagnostic imaging; Anal Canal - injuries; Anal Canal - surgery; anal sphincter laceration; Anus Diseases - diagnostic imaging; Anus Diseases - etiology; Anus Diseases - surgery; Biological and medical sciences; Delivery, Obstetric - adverse effects; Delivery. Postpartum. Lactation; endoanal ultrasound; Episiotomy; Female; Gynecology. Andrology. Obstetrics; Humans; Lacerations - diagnostic imaging; Lacerations - etiology; Lacerations - surgery; Medical sciences; Obstetric Labor Complications - diagnostic imaging; Obstetric Labor Complications - etiology; Obstetric Labor Complications - surgery; Obstetrics and Gynecology; postpartum fecal incontinence; Pregnancy; Prospective Studies; Risk Factors; Ultrasonography; postpartum fecal incontinence; anal sphincter laceration; endoanal ultrasound; Sonography; Human; Echography; Risk factor; Break; Complication; Delivery; Epidemiology; Obstetrics; Anal sphincter
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2007.06.034

Objective The objective of the study was to identify risk factors for internal anal sphincter (IAS) gaps on postpartum endoanal ultrasound in women with obstetric anal sphincter tear. Study Design This prospective study included 106 women from the Childbirth and Pelvic Symptoms Imaging Supplementary Study who had third- or fourth-degree perineal laceration at delivery and endoanal ultrasound 6-12 months postpartum. Data were analyzed using Fisher’s exact and t tests and logistic regression. Results Mean (± SD) age was 27.7 (± 6.2) years. Seventy-nine women (76%) were white and 22 (21%) black. Thirty-seven (35%) had sonographic IAS gaps. Risk factors for gaps included fourth- vs third-degree perineal laceration (odds ratio [OR] 15.4, 95% confidence interval [CI] 4.8, 50) and episiotomy (OR 3.3, 95% CI 1.2, 9.1). Black race (OR 0.23, 95% CI 0.05, 0.96) was protective. Conclusion In women with obstetric anal sphincter repairs, fourth-degree tears and episiotomy are associated with more frequent sonographic IAS gaps.