Anal incontinence in women with recurrent obstetric anal sphincter rupture: a case control study.

OBJECTIVES: To determine the risk of recurrent anal sphincter rupture (ASR), and compare the risk of anal incontinence (AI) after recurrent ASR, with that seen in women with previous ASR who deliver by caesarean section or vaginally without sustaining a recurrent ASR. METHODS: Women with recurrent ASR between January 2000 and June 2011 were identified at two delivery wards in Copenhagen. The women answered a questionnaire with a validated scoring system for AI (St. Mark`s score), and the results were compared with those obtained in two control groups: women with subsequent uncomplicated vaginal delivery or caesarean section. RESULTS: There were 93 437 vaginal deliveries. ASR occurred in 5.5% (n = 2851) of the nulliparous and 1.5% (n = 608) of the multiparous women. Recurrent ASR occurred in 8% (n = 49) of whom 50% reported symptoms of AI. We found no difference in the occurrence of AI between women with recurrent ASR, and those who delivered vaginally without repeat ASR (p = 0.37; OR = 2.0) or by caesarean section (p = 0.77; OR = 1.3). CONCLUSION: Women with a past history of ASR have an 8% risk of recurrence. AI affects half of the women with recurrent ASR. Larger studies are required to confirm our findings.

Maternal and perinatal complications by day of gestation after spontaneous labor at 40-42 weeks of gestation.

OBJECTIVE: To evaluate pregnancy outcome after spontaneous labor by day of gestation between 40(+0) and 41(+6) weeks of gestation. DESIGN: Evaluation of prospectively collected labor ward data. SETTING: University Hospital, Denmark. POPULATION: Unselected consecutive cohort of 14 678 spontaneously starting deliveries between 280 and 293 days of gestation during the years 2000-2006. METHODS: Data were registered in a computer program after each delivery by a midwife and the entries further evaluated by a specialist in obstetrics. Complication rates were compared using Fisher's exact test. MAIN OUTCOME MEASURES: Maternal complication rates for each gestation day, including cesarean delivery, maternal blood transfusion, episiotomy, operative vaginal delivery, third and fourth degree perineal lacerations and perinatal morbidity. RESULTS: The cesarean delivery rate increased from 6% on day 280 to 11% on day 293. Cesarean delivery increased from 40 to 41 weeks gestation (7.3 vs. 9.5%, p<0.005), as did maternal transfusion (0.5 vs. 1.2%, p<0.001) and cesarean section on the indication fetal distress (1.5 versus 2.4%, p<0.005), but perineal lacerations did not. Likewise, there was an increase in episiotomy rates (3.0 vs. 3.5%, p=0.08), operative vaginal delivery (5.8 vs. 6.5%, p=0.07) and admission to neonatal intensive care (1.4 versus 2.0%, p=0.009), but no increase in 5 minute Apgar scores <7 or low umbilical artery acid-base values. CONCLUSIONS: Deliveries starting spontaneously in an unselected cohort showed an increase in maternal complications, meconium-stained amniotic fluid and admission to the neonatal intensive care unit.