RESUMEN
OBJECTIVE: The purpose of this study was to determine the rate of new bowel symptoms and anal sphincter defects in primiparous women with and without recognized anal sphincter (AS) injury. STUDY DESIGN: One hundred seventeen primiparous women classified with increasing degrees of perineal trauma and 21 controls delivered by cesarean section were enrolled immediately postpartum and demographic and delivery data were collected. At 6 weeks' postpartum, subjects completed a bowel function questionnaire and endoanal ultrasonography was performed. Logistic regression, chi-square, and 2-sample t tests were used for statistical analysis. RESULTS: A significant difference in new bowel symptoms was reported in women with (39%) and without (11%) recognized AS injury (P = .002). AS defects were present in 0%, 15%, 23%, 37%, and 67% of women with C/S, first-, second-, third-, and fourth-degree lacerations, respectively. Combined defects of the internal and external AS were associated with the greatest risk of new bowel symptoms (OR 32.1 [95% CI 9.6-107], P < .001). CONCLUSION: In women with and without recognized AS trauma, new bowel symptoms were strongly correlated with the presence of anatomic AS defects postpartum.
Asunto(s)
Canal Anal/lesiones , Enfermedades del Ano/complicaciones , Enfermedades Intestinales/etiología , Laceraciones/complicaciones , Paridad , Parto , Adulto , Canal Anal/diagnóstico por imagen , Estudios de Casos y Controles , Estudios de Cohortes , Parto Obstétrico/efectos adversos , Endosonografía , Femenino , Humanos , Laceraciones/diagnóstico por imagen , Laceraciones/etiología , Perineo/lesiones , Periodo Posparto , Embarazo , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Heridas y Lesiones/complicaciones , Heridas y Lesiones/diagnóstico por imagenRESUMEN
OBJECTIVE: The purpose of this study was to compare outcomes after third- versus fourth-degree laceration repair. STUDY DESIGN: Fifty-six primiparous women who sustained a third- or fourth-degree tear were enrolled at delivery and demographic and obstetric data were collected. At 6 weeks' postpartum, subjects completed a bowel function questionnaire and endoanal ultrasonography was performed. Fisher exact test and chi-square were used for statistical analysis. RESULTS: Thirty-nine women with third- and 17 with fourth-degree tears were enrolled. Subjects with fourth- were more likely to report bowel symptoms (59% vs 28%, P = .03), and to demonstrate persistent combined defects of the internal (IAS) and external anal sphincter (EAS) (48% vs 8%, P = .002) than third-degree tears. Combined defects were associated with the highest risk of bowel symptoms (OR 18.7, 95% CI 3-101, P < .001). CONCLUSION: Bowel symptoms were more common after fourth- than third-degree repair, and may be secondary to higher rates of combined defects of the IAS and EAS.