Journal article
Diagnosis of anal sphincter tears to prevent fecal incontinence: a randomized controlled trial.
- Faltin DL Department of Obstetrics and Gynecology, Faculty of Medicine, University of Geneva and University Hospitals of Geneva, Switzerland. daniel.faltin@hcuge.ch
- Boulvain M
- Floris LA
- Irion O
- 2005-07-05
Published in:
- Obstetrics and gynecology. - 2005
Adult
Anal Canal
Anus Diseases
Confidence Intervals
Endosonography
Fecal Incontinence
Female
Follow-Up Studies
Humans
Lacerations
Maternal Age
Obstetric Labor Complications
Parity
Perineum
Postpartum Period
Pregnancy
Primary Prevention
Probability
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
English
OBJECTIVE
Maternal anal sphincter tears after vaginal delivery are frequently not diagnosed clinically and are associated with subsequent fecal incontinence. This study examined whether diagnosis of these tears by ultrasonography, followed by immediate surgical repair, reduces the occurrence of incontinence.
METHODS
We conducted a randomized trial involving 752 primiparous women without a clinically evident anal sphincter tear to evaluate the benefit of adding endoanal ultrasonography immediately after vaginal delivery to the standard clinical examination of the perineum. When a sphincter tear was diagnosed, the perineum was surgically explored and the sphincter sutured. The main outcome evaluated was fecal incontinence 3 months postpartum graded by the Wexner incontinence scale, which measures incontinence to flatus and liquid or solid stools, need to wear a pad, and lifestyle alterations.
RESULTS
Among women assessed by ultrasonography, 5.6% had a sphincter tear. Severe incontinence was reported 3 months after childbirth by 3.3% of women in the intervention group compared with 8.7% in the control group (risk difference -5.4%; 95% confidence interval -8.9 to -2.0; P = .002). The benefit of the intervention persisted 1 year after delivery, with 3.2% severe incontinence in the intervention group compared with 6.7% in the control group (risk difference -3.5%; 95% confidence interval -6.8% to -0.3%; P = .03). Ultrasonography needs to be performed in 29 women to prevent 1 case of severe fecal incontinence.
CONCLUSION
Ultrasound examination of the perineum after childbirth improves the diagnosis of anal sphincter tears, and their immediate repair decreases the risk of severe fecal incontinence.
LEVEL OF EVIDENCE
I.
Maternal anal sphincter tears after vaginal delivery are frequently not diagnosed clinically and are associated with subsequent fecal incontinence. This study examined whether diagnosis of these tears by ultrasonography, followed by immediate surgical repair, reduces the occurrence of incontinence.
METHODS
We conducted a randomized trial involving 752 primiparous women without a clinically evident anal sphincter tear to evaluate the benefit of adding endoanal ultrasonography immediately after vaginal delivery to the standard clinical examination of the perineum. When a sphincter tear was diagnosed, the perineum was surgically explored and the sphincter sutured. The main outcome evaluated was fecal incontinence 3 months postpartum graded by the Wexner incontinence scale, which measures incontinence to flatus and liquid or solid stools, need to wear a pad, and lifestyle alterations.
RESULTS
Among women assessed by ultrasonography, 5.6% had a sphincter tear. Severe incontinence was reported 3 months after childbirth by 3.3% of women in the intervention group compared with 8.7% in the control group (risk difference -5.4%; 95% confidence interval -8.9 to -2.0; P = .002). The benefit of the intervention persisted 1 year after delivery, with 3.2% severe incontinence in the intervention group compared with 6.7% in the control group (risk difference -3.5%; 95% confidence interval -6.8% to -0.3%; P = .03). Ultrasonography needs to be performed in 29 women to prevent 1 case of severe fecal incontinence.
CONCLUSION
Ultrasound examination of the perineum after childbirth improves the diagnosis of anal sphincter tears, and their immediate repair decreases the risk of severe fecal incontinence.
LEVEL OF EVIDENCE
I.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1097/01.AOG.0000165273.68486.95
- PMID 15994610
- Persistent URL
- https://sonar.ch/global/documents/219872
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