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Erschienen in: International Urogynecology Journal 12/2015

01.12.2015 | Review Article

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

verfasst von: Dharmesh S. Kapoor, Ranee Thakar, Abdul H. Sultan

Erschienen in: International Urogynecology Journal | Ausgabe 12/2015

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Abstract

Introduction and hypothesis

Obstetric anal sphincter injuries (OASIs) are the leading cause of anal incontinence in women. Modification of various risk factors and anatomical considerations have been reported to reduce the rate of OASI.

Methods

A PubMed search (1989–2014) of studies and systematic reviews on risk factors for OASI.

Results

Perineal distension (stretching) of 170 % in the transverse direction and 40 % in the vertical direction occurs at crowning, leading to significant differences (15–30°) between episiotomy incision angles and suture angles. Episiotomies incised at 60° achieve suture angles of 43–50°; those incised at 40° result in a suture angle of 22°. Episiotomies with suture angles too acute (<30°) and too lateral (>60°) are associated with an increased risk of OASI. Suture angles of 40–60° are in the safe zone. Clinicians are poor at correctly estimating episiotomy angles on paper and in patients. Sutured episiotomies originating 10 mm away from the midline are associated with a lower rate of OASIs. Compared to spontaneous tears, episiotomies appear to be associated with a reduction in OASI risk by 40–50 %, whereas shorter perineal lengths, perineal oedema and instrumental deliveries are associated with a higher risk. Instrumental deliveries with mediolateral episiotomies are associated with a significantly lower OASI risk. Other preventative measures include warm perineal compresses and controlled delivery of the head.

Conclusions

Relieving pressure on the central posterior perineum by an episiotomy and/or controlled delivery of the head should be important considerations in reducing the risk of OASI. Episiotomies should be performed 60° from the midline. Prospective studies should evaluate elective episiotomies in women with a short perineal length and application of standardised digital perineal support.
Literatur
1.
Zurück zum Zitat Oberwalder M, Connor J, Wexner SD (2003) Meta-analysis to determine the incidence of obstetric anal sphincter damage. Br J Surg 90:1333–1337CrossRefPubMed Oberwalder M, Connor J, Wexner SD (2003) Meta-analysis to determine the incidence of obstetric anal sphincter damage. Br J Surg 90:1333–1337CrossRefPubMed
2.
Zurück zum Zitat Mous M, Muller SA, de Leeuw JW (2008) Long term effects of anal sphincter rupture during vaginal delivery: fecal incontinence and sexual complaints. BJOG 115:234–238CrossRefPubMed Mous M, Muller SA, de Leeuw JW (2008) Long term effects of anal sphincter rupture during vaginal delivery: fecal incontinence and sexual complaints. BJOG 115:234–238CrossRefPubMed
3.
Zurück zum Zitat Evers EC, Blomquist JL, McDermott KC, Handa VL (2012) Obstetrical anal sphincter laceration and anal incontinence 5-10 years after childbirth. Am J Obstet Gynecol 207:425.e1–425.e6CrossRef Evers EC, Blomquist JL, McDermott KC, Handa VL (2012) Obstetrical anal sphincter laceration and anal incontinence 5-10 years after childbirth. Am J Obstet Gynecol 207:425.e1–425.e6CrossRef
4.
Zurück zum Zitat Soerensen MM, Buntzen S, Bek KM, Laurberg S (2013) Complete obstetric anal sphincter tear and risk of long-term fecal incontinence: a cohort study. Dis Colon Rectum 56:992–1001CrossRefPubMed Soerensen MM, Buntzen S, Bek KM, Laurberg S (2013) Complete obstetric anal sphincter tear and risk of long-term fecal incontinence: a cohort study. Dis Colon Rectum 56:992–1001CrossRefPubMed
5.
Zurück zum Zitat Gurol-Urganci I, Cromwell D, Edozien L, Mahmood T, Adams E, Richmond D, Templeton A, van der Meulen J (2013) Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG 120(12):1516–1525CrossRefPubMed Gurol-Urganci I, Cromwell D, Edozien L, Mahmood T, Adams E, Richmond D, Templeton A, van der Meulen J (2013) Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG 120(12):1516–1525CrossRefPubMed
6.
Zurück zum Zitat Thiagamoorthy G, Johnson A, Thakar R, Sultan AH (2014) National survey of perineal trauma and its subsequent management in the United Kingdom. Int Urogynecol J 25(12):1621–1627CrossRefPubMed Thiagamoorthy G, Johnson A, Thakar R, Sultan AH (2014) National survey of perineal trauma and its subsequent management in the United Kingdom. Int Urogynecol J 25(12):1621–1627CrossRefPubMed
7.
Zurück zum Zitat Sultan AH, Kamm MA, Hudson CN, Bartram CI (1994) Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 308:887–891PubMedCentralCrossRefPubMed Sultan AH, Kamm MA, Hudson CN, Bartram CI (1994) Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 308:887–891PubMedCentralCrossRefPubMed
8.
Zurück zum Zitat Fitzpatrick M, McQuillan K, O'Herlihy C (2001) Influence of persistent occiput posterior position on delivery outcome. Obstet Gynecol 98:1027–1031CrossRefPubMed Fitzpatrick M, McQuillan K, O'Herlihy C (2001) Influence of persistent occiput posterior position on delivery outcome. Obstet Gynecol 98:1027–1031CrossRefPubMed
9.
Zurück zum Zitat de Leeuw JW, Struijk PC, Vierhout ME, Wallenburg HC (2001) Risk factors for third degree perineal ruptures during delivery. BJOG 108:383–387PubMed de Leeuw JW, Struijk PC, Vierhout ME, Wallenburg HC (2001) Risk factors for third degree perineal ruptures during delivery. BJOG 108:383–387PubMed
10.
Zurück zum Zitat Wu JM, Williams KS, Hundley AF, Connolly A, Visco AG (2005) Occiput posterior fetal head position increases the risk of anal sphincter injury in vacuum-assisted deliveries. Am J Obstet Gynecol 193:525–529CrossRefPubMed Wu JM, Williams KS, Hundley AF, Connolly A, Visco AG (2005) Occiput posterior fetal head position increases the risk of anal sphincter injury in vacuum-assisted deliveries. Am J Obstet Gynecol 193:525–529CrossRefPubMed
11.
Zurück zum Zitat Benavides L, Wu JM, Hundley AF, Ivester TS, Visco AG (2005) The impact of occiput posterior fetal head position on the risk of anal sphincter injury in forceps-assisted vaginal deliveries. Am J Obstet Gynecol 192:1702–1706CrossRefPubMed Benavides L, Wu JM, Hundley AF, Ivester TS, Visco AG (2005) The impact of occiput posterior fetal head position on the risk of anal sphincter injury in forceps-assisted vaginal deliveries. Am J Obstet Gynecol 192:1702–1706CrossRefPubMed
12.
Zurück zum Zitat Revicky V, Nirmal D, Mukhopadhyay S, Morris EP, Nieto JJ (2010) Could a mediolateral episiotomy prevent obstetric anal sphincter injury? Eur J Obstet Gynecol Reprod Biol 150:142–146CrossRefPubMed Revicky V, Nirmal D, Mukhopadhyay S, Morris EP, Nieto JJ (2010) Could a mediolateral episiotomy prevent obstetric anal sphincter injury? Eur J Obstet Gynecol Reprod Biol 150:142–146CrossRefPubMed
13.
Zurück zum Zitat Andrews V, Thakar R, Sultan AH, Jones PW (2005) Are mediolateral episiotomies actually mediolateral? BJOG 112:1156–1158CrossRefPubMed Andrews V, Thakar R, Sultan AH, Jones PW (2005) Are mediolateral episiotomies actually mediolateral? BJOG 112:1156–1158CrossRefPubMed
14.
Zurück zum Zitat Eogan M, Daly L, O'Connell PR, O'Herlihy C (2006) Does the angle of episiotomy affect the incidence of anal sphincter injury? BJOG 113:190–194CrossRefPubMed Eogan M, Daly L, O'Connell PR, O'Herlihy C (2006) Does the angle of episiotomy affect the incidence of anal sphincter injury? BJOG 113:190–194CrossRefPubMed
15.
Zurück zum Zitat Stedenfeldt M, Pirhonen J, Blix E, Wilsqaard T, Vonen B, Qian P (2012) Episiotomy characteristics and risks for obstetric anal sphincter injury: a case-control study. BJOG 119:724–730PubMedCentralCrossRefPubMed Stedenfeldt M, Pirhonen J, Blix E, Wilsqaard T, Vonen B, Qian P (2012) Episiotomy characteristics and risks for obstetric anal sphincter injury: a case-control study. BJOG 119:724–730PubMedCentralCrossRefPubMed
16.
Zurück zum Zitat Aasheim V, Nilsen ABV, Lukasse M, Reinar LM (2011) Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD006672. doi:10.1002/14651858.CD006672.pub2 Aasheim V, Nilsen ABV, Lukasse M, Reinar LM (2011) Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD006672. doi:10.​1002/​14651858.​CD006672.​pub2
19.
Zurück zum Zitat Fodstad K, Laine K, Staff AC (2013) Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study. Int Urogynecol J 24:865–872CrossRefPubMed Fodstad K, Laine K, Staff AC (2013) Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study. Int Urogynecol J 24:865–872CrossRefPubMed
20.
Zurück zum Zitat Green JR, Soohoo S (1989) Factors associated with rectal injury in spontaneous deliveries. Obstet Gynecol 73:732–738PubMed Green JR, Soohoo S (1989) Factors associated with rectal injury in spontaneous deliveries. Obstet Gynecol 73:732–738PubMed
21.
Zurück zum Zitat Zemcik R, Karbanova J, Kalis V, Lobovsky L, Jansova M, Rusavy Z (2012) Stereophotogrammetry of the perineum during vaginal delivery. Int J Gynaecol Obstet 119:76–80CrossRefPubMed Zemcik R, Karbanova J, Kalis V, Lobovsky L, Jansova M, Rusavy Z (2012) Stereophotogrammetry of the perineum during vaginal delivery. Int J Gynaecol Obstet 119:76–80CrossRefPubMed
22.
Zurück zum Zitat Jansova M, Kalis V, Rusavy Z, Zemcik R, Lobovsky L, Laine K (2014) Modelling manual perineal protection during vaginal delivery. Int Urogynecol J 25:65–71CrossRefPubMed Jansova M, Kalis V, Rusavy Z, Zemcik R, Lobovsky L, Laine K (2014) Modelling manual perineal protection during vaginal delivery. Int Urogynecol J 25:65–71CrossRefPubMed
23.
Zurück zum Zitat Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17CrossRefPubMed Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17CrossRefPubMed
24.
Zurück zum Zitat Cundiff GW, Harris RL, Coates K, Low VH, Bump RC, Addison WA (1997) Abdominal sacral colpoperineopexy: a new approach of posterior compartment defects and perineal descent associated with vaginal vault prolapse. Am J Obstet Gynecol 177:1345–1353CrossRefPubMed Cundiff GW, Harris RL, Coates K, Low VH, Bump RC, Addison WA (1997) Abdominal sacral colpoperineopexy: a new approach of posterior compartment defects and perineal descent associated with vaginal vault prolapse. Am J Obstet Gynecol 177:1345–1353CrossRefPubMed
25.
Zurück zum Zitat Delancey JO, Hurd WW (1998) Size of the urogenital hiatus in the levator ani in normal women and women with pelvic organ prolapse. Obstet Gynecol 91:364–368CrossRefPubMed Delancey JO, Hurd WW (1998) Size of the urogenital hiatus in the levator ani in normal women and women with pelvic organ prolapse. Obstet Gynecol 91:364–368CrossRefPubMed
26.
Zurück zum Zitat Deering SH, Carlson N, Stitely M, Allaire AD, Satin AJ (2004) Perineal body length and lacerations at delivery. J Reprod Med 49:306–310PubMed Deering SH, Carlson N, Stitely M, Allaire AD, Satin AJ (2004) Perineal body length and lacerations at delivery. J Reprod Med 49:306–310PubMed
27.
Zurück zum Zitat Rizk DEE, Abadir MN, Thomas LB, Abu-Zidan F (2005) Determinants of the length of episiotomy or spontaneous perineal lacerations during vaginal birth. Int Urogynecol J 16:395–400CrossRef Rizk DEE, Abadir MN, Thomas LB, Abu-Zidan F (2005) Determinants of the length of episiotomy or spontaneous perineal lacerations during vaginal birth. Int Urogynecol J 16:395–400CrossRef
28.
Zurück zum Zitat Dua A, Whitworth M, Dugdale A, Hill S (2009) Perineal length: norms in gravid women in the first stage of labour. Int Urogynecol J 20:1361–1364CrossRef Dua A, Whitworth M, Dugdale A, Hill S (2009) Perineal length: norms in gravid women in the first stage of labour. Int Urogynecol J 20:1361–1364CrossRef
29.
Zurück zum Zitat Tsai PS, Oyama IA, Hiraoka M, Minaglia S, Thomas J, Kaneshiro B (2012) Perineal body length among different racial groups in the first stage of labour. Female Pelvic Med Reconstr Surg 18:165–167CrossRefPubMed Tsai PS, Oyama IA, Hiraoka M, Minaglia S, Thomas J, Kaneshiro B (2012) Perineal body length among different racial groups in the first stage of labour. Female Pelvic Med Reconstr Surg 18:165–167CrossRefPubMed
30.
Zurück zum Zitat Geller EJ, Robinson BL, Matthews CA, Celauro KP, Dunivan GC, Crane AK, Ivins AR, Woodham PC, Fielding JR (2014) Perineal body length as a risk factor for ultrasound-diagnosed anal sphincter tear at first delivery. Int Urogynecol J 25:631–636CrossRefPubMed Geller EJ, Robinson BL, Matthews CA, Celauro KP, Dunivan GC, Crane AK, Ivins AR, Woodham PC, Fielding JR (2014) Perineal body length as a risk factor for ultrasound-diagnosed anal sphincter tear at first delivery. Int Urogynecol J 25:631–636CrossRefPubMed
31.
Zurück zum Zitat Lai CY, Cheung HW, His Lao TT, Lau TK, Leung TY (2009) Is the policy of restrictive episiotomy generalizable? A prospective observational study. J Matern Fetal Neonatal Med 22:1116–1121CrossRefPubMed Lai CY, Cheung HW, His Lao TT, Lau TK, Leung TY (2009) Is the policy of restrictive episiotomy generalizable? A prospective observational study. J Matern Fetal Neonatal Med 22:1116–1121CrossRefPubMed
32.
Zurück zum Zitat Walfisch A, Hallak M, Harley S, Mazor M, Shoham-Vardi I (2005) Association of spontaneous perineal stretching during delivery with perineal lacerations. J Reprod Med 50:23–28PubMed Walfisch A, Hallak M, Harley S, Mazor M, Shoham-Vardi I (2005) Association of spontaneous perineal stretching during delivery with perineal lacerations. J Reprod Med 50:23–28PubMed
33.
Zurück zum Zitat Kalis V, Karbanova J, Bukacova Z, Bednarova B, Rokyta Z, Kralickova M (2010) Anal dilatation during labor. Int J Gynaecol Obstet 109:136–139CrossRefPubMed Kalis V, Karbanova J, Bukacova Z, Bednarova B, Rokyta Z, Kralickova M (2010) Anal dilatation during labor. Int J Gynaecol Obstet 109:136–139CrossRefPubMed
34.
Zurück zum Zitat Aytan H, Tapisiz OL, Tuncay G, Avsar FA (2005) Severe perineal lacerations in nulliparous women and episiotomy type. Eur J Obstet Gynecol Reprod Biol 121:46–50CrossRefPubMed Aytan H, Tapisiz OL, Tuncay G, Avsar FA (2005) Severe perineal lacerations in nulliparous women and episiotomy type. Eur J Obstet Gynecol Reprod Biol 121:46–50CrossRefPubMed
35.
Zurück zum Zitat Kalis V, Karbanova J, Horak M, Lobovsky L, Kralickova M, Rokyta Z (2008) The incision angle of mediolateral episiotomy before delivery and after repair. Int J Gynaecol Obstet 103:5–8CrossRefPubMed Kalis V, Karbanova J, Horak M, Lobovsky L, Kralickova M, Rokyta Z (2008) The incision angle of mediolateral episiotomy before delivery and after repair. Int J Gynaecol Obstet 103:5–8CrossRefPubMed
36.
Zurück zum Zitat Kalis V, Landsmanova J, Bednarova B, Karbanova J, Laine K, Rokyta Z (2011) Evaluation of the incision angle of mediolateral episiotomy at 60 degrees. Int J Gynaecol Obstet 112:220–224CrossRefPubMed Kalis V, Landsmanova J, Bednarova B, Karbanova J, Laine K, Rokyta Z (2011) Evaluation of the incision angle of mediolateral episiotomy at 60 degrees. Int J Gynaecol Obstet 112:220–224CrossRefPubMed
37.
Zurück zum Zitat Freeman RM, Hollands H, Barron L, Kapoor DS (2014) Cutting a mediolateral episiotomy at the correct angle: evaluation of a new device: the Episcissors-60. Med Devices (Auckl) 7:23–28. doi:10.2147/MDER.S60056 Freeman RM, Hollands H, Barron L, Kapoor DS (2014) Cutting a mediolateral episiotomy at the correct angle: evaluation of a new device: the Episcissors-60. Med Devices (Auckl) 7:23–28. doi:10.​2147/​MDER.​S60056
38.
Zurück zum Zitat Patel R, Ubale S (2014) Evaluation of the angled Episcissors-60(®) episiotomy scissors in spontaneous vaginal deliveries. Med Devices (Auckl) 7:253–256CrossRef Patel R, Ubale S (2014) Evaluation of the angled Episcissors-60(®) episiotomy scissors in spontaneous vaginal deliveries. Med Devices (Auckl) 7:253–256CrossRef
39.
Zurück zum Zitat Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA (2004) Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol 103:31–40PubMedCentralCrossRefPubMed Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA (2004) Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol 103:31–40PubMedCentralCrossRefPubMed
40.
Zurück zum Zitat Eliashiv O, Ginath S, Weiner E, Sadan O, Golan A, Condrea A (2013) Mediolateral episiotomy-is the angle of incision performed at crowning the correct and desired one? Int Urogynecol J 24:S68 Eliashiv O, Ginath S, Weiner E, Sadan O, Golan A, Condrea A (2013) Mediolateral episiotomy-is the angle of incision performed at crowning the correct and desired one? Int Urogynecol J 24:S68
41.
Zurück zum Zitat Samuelsson E, Ladfors L, Wennerholm UB, Gareberg B, Nyberg K, Hagberg H (2000) Anal sphincter tears: prospective study of obstetric risk factors. BJOG 107:926–931CrossRefPubMed Samuelsson E, Ladfors L, Wennerholm UB, Gareberg B, Nyberg K, Hagberg H (2000) Anal sphincter tears: prospective study of obstetric risk factors. BJOG 107:926–931CrossRefPubMed
42.
Zurück zum Zitat Handa VL, Danielsen BH, Gilbert WM (2001) Obstetric anal sphincter lacerations. Obstet Gynecol 98:225–230CrossRefPubMed Handa VL, Danielsen BH, Gilbert WM (2001) Obstetric anal sphincter lacerations. Obstet Gynecol 98:225–230CrossRefPubMed
43.
Zurück zum Zitat Combs CA, Roberston PA, Laros RK (1990) Risk factors for third and fourth degree perineal lacerations in forceps and vacuum deliveries. Am J Obstet Gynecol 163:100–104CrossRefPubMed Combs CA, Roberston PA, Laros RK (1990) Risk factors for third and fourth degree perineal lacerations in forceps and vacuum deliveries. Am J Obstet Gynecol 163:100–104CrossRefPubMed
44.
Zurück zum Zitat Hopkins LM, Caughey AB, Glidden DV, Laros RK Jr (2005) Racial/ethnic differences perineal, vaginal and cervical lacerations. Am J Obstet Gynecol 193:455–459CrossRefPubMed Hopkins LM, Caughey AB, Glidden DV, Laros RK Jr (2005) Racial/ethnic differences perineal, vaginal and cervical lacerations. Am J Obstet Gynecol 193:455–459CrossRefPubMed
45.
46.
Zurück zum Zitat Donnelly V, Fynes M, Campbell D, Johnson H, O'Connell PR, O’Herlihy C (1998) Obstetric events leading to anal sphincter damage. Obstet Gynecol 92:955–961CrossRefPubMed Donnelly V, Fynes M, Campbell D, Johnson H, O'Connell PR, O’Herlihy C (1998) Obstetric events leading to anal sphincter damage. Obstet Gynecol 92:955–961CrossRefPubMed
47.
Zurück zum Zitat Andrews V, Sultan AH, Thakar R, Jones PW (2006) Risk factors for obstetric anal sphincter injury: a prospective study. Birth 33:117–122CrossRefPubMed Andrews V, Sultan AH, Thakar R, Jones PW (2006) Risk factors for obstetric anal sphincter injury: a prospective study. Birth 33:117–122CrossRefPubMed
48.
Zurück zum Zitat Gottvall K, Allebeck P, Ekéus C (2007) Risk factors for anal sphincter tears: the importance of maternal position at birth. BJOG 114:1266–1272CrossRefPubMed Gottvall K, Allebeck P, Ekéus C (2007) Risk factors for anal sphincter tears: the importance of maternal position at birth. BJOG 114:1266–1272CrossRefPubMed
49.
Zurück zum Zitat Richter HE, Nager CW, Burgio KL, Whitworth R, Weidner AC, Schaffer J et al (2015) Incidence and predictors of anal incontinence after obstetric anal sphincter injury in primiparous women. Female Pelvic Med Reconstr Surg. doi:10.1097/SPV.0000000000000160 Richter HE, Nager CW, Burgio KL, Whitworth R, Weidner AC, Schaffer J et al (2015) Incidence and predictors of anal incontinence after obstetric anal sphincter injury in primiparous women. Female Pelvic Med Reconstr Surg. doi:10.​1097/​SPV.​0000000000000160​
50.
Zurück zum Zitat Aiken CE, Aiken AR, Prentice A (2015) Influence of the duration of the second stage of labor on the likelihood of obstetric anal sphincter injury. Birth 42:86–93CrossRefPubMed Aiken CE, Aiken AR, Prentice A (2015) Influence of the duration of the second stage of labor on the likelihood of obstetric anal sphincter injury. Birth 42:86–93CrossRefPubMed
51.
Zurück zum Zitat Fitzpatrick M, Harkin R, McQuillan K, O'Brien C, O'Connell PR, O'Herlihy C (2002) A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal continence. BJOG 109:1359–1365CrossRefPubMed Fitzpatrick M, Harkin R, McQuillan K, O'Brien C, O'Connell PR, O'Herlihy C (2002) A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal continence. BJOG 109:1359–1365CrossRefPubMed
52.
Zurück zum Zitat Christianson LM, Bovbjerg VE, McDavitt EC, Hullfish KL (2003) Risk factors for perineal injury during delivery. Am J Obstet Gynecol 189:255–260CrossRefPubMed Christianson LM, Bovbjerg VE, McDavitt EC, Hullfish KL (2003) Risk factors for perineal injury during delivery. Am J Obstet Gynecol 189:255–260CrossRefPubMed
54.
Zurück zum Zitat Jango H, Langhoff-Roos J, Rosthoj S, Sakse A (2014) Modifiable risk factors for obstetric anal sphincter injury in primiparous women: a population based cohort study. Am J Obstet Gynecol 210:59.e1–59.e6CrossRef Jango H, Langhoff-Roos J, Rosthoj S, Sakse A (2014) Modifiable risk factors for obstetric anal sphincter injury in primiparous women: a population based cohort study. Am J Obstet Gynecol 210:59.e1–59.e6CrossRef
55.
Zurück zum Zitat Baumann P, Hammoud AO, McNeeley SG, DeRose E, Kudish B, Hendrix S (2007) Factors associated with anal sphincter laceration in 40,923 primiparous women. Int Urogynecol J 18:985–990CrossRef Baumann P, Hammoud AO, McNeeley SG, DeRose E, Kudish B, Hendrix S (2007) Factors associated with anal sphincter laceration in 40,923 primiparous women. Int Urogynecol J 18:985–990CrossRef
56.
Zurück zum Zitat Roos A-M, Thakar R, Sultan AH (2010) Outcome of primary repair of obstetric anal sphincter injuries (OASIS): does the grade of tear matter? Ultrasound Obstet Gynecol 36(3):368–374CrossRefPubMed Roos A-M, Thakar R, Sultan AH (2010) Outcome of primary repair of obstetric anal sphincter injuries (OASIS): does the grade of tear matter? Ultrasound Obstet Gynecol 36(3):368–374CrossRefPubMed
57.
58.
Zurück zum Zitat DeLancey JO (1992) Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 166:1717–1724CrossRefPubMed DeLancey JO (1992) Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 166:1717–1724CrossRefPubMed
59.
Zurück zum Zitat Gainey HL (1943) Postpartum observation of pelvic tissue damage. Am J Obstet Gynecol 45:457–466 Gainey HL (1943) Postpartum observation of pelvic tissue damage. Am J Obstet Gynecol 45:457–466
60.
Zurück zum Zitat Gainey HL (1955) Postpartum observation of pelvic tissue damage: further studies. Am J Obstet Gynecol 70:800–807PubMed Gainey HL (1955) Postpartum observation of pelvic tissue damage: further studies. Am J Obstet Gynecol 70:800–807PubMed
61.
Zurück zum Zitat Ranney B (1990) Decreasing numbers of patients for vaginal hysterectomy and plasty. S D J Med J 43:7–12 Ranney B (1990) Decreasing numbers of patients for vaginal hysterectomy and plasty. S D J Med J 43:7–12
62.
Zurück zum Zitat Patel DA, Xu X, Thomason AD, Ransom SB, Ivy JS, DeLancey JO (2006) Childbirth and pelvic floor dysfunction: an epidemiological approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol 195:23–28PubMedCentralCrossRefPubMed Patel DA, Xu X, Thomason AD, Ransom SB, Ivy JS, DeLancey JO (2006) Childbirth and pelvic floor dysfunction: an epidemiological approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol 195:23–28PubMedCentralCrossRefPubMed
63.
64.
Zurück zum Zitat Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO (2003) Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 189:1543–1549CrossRefPubMed Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO (2003) Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 189:1543–1549CrossRefPubMed
66.
68.
Zurück zum Zitat Kalis V, Laine K, de Leeuw JW, Ismail KM, Tincello DG (2012) Classification of episiotomy: towards a standardisation of terminology. BJOG 119:522–526CrossRefPubMed Kalis V, Laine K, de Leeuw JW, Ismail KM, Tincello DG (2012) Classification of episiotomy: towards a standardisation of terminology. BJOG 119:522–526CrossRefPubMed
69.
Zurück zum Zitat Beischer NA, MacKay EV (1986) Episiotomy. In: Obstetrics and The Newborn. London: Bailliere Tindall. Obstetric procedures. In: Chamberlain GVP (ed). Obstetrics by Ten Teachers. London: Arnold, 1995:285–303 Beischer NA, MacKay EV (1986) Episiotomy. In: Obstetrics and The Newborn. London: Bailliere Tindall. Obstetric procedures. In: Chamberlain GVP (ed). Obstetrics by Ten Teachers. London: Arnold, 1995:285–303
70.
Zurück zum Zitat Tincello DG, Williams A, Fowler GE, Adams EJ, Richmond DH, Alfirevic Z (2003) Differences in episiotomy technique between midwives and doctors. BJOG 110:1041–1044CrossRefPubMed Tincello DG, Williams A, Fowler GE, Adams EJ, Richmond DH, Alfirevic Z (2003) Differences in episiotomy technique between midwives and doctors. BJOG 110:1041–1044CrossRefPubMed
71.
Zurück zum Zitat Angioli R, Gomez-Marin O, Cantuaria G, O’Sullivan MJ (2000) Severe perineal lacerations during vaginal delivery: the University of Miami experience. Am J Obstet Gynecol 182:1083–1085CrossRefPubMed Angioli R, Gomez-Marin O, Cantuaria G, O’Sullivan MJ (2000) Severe perineal lacerations during vaginal delivery: the University of Miami experience. Am J Obstet Gynecol 182:1083–1085CrossRefPubMed
72.
Zurück zum Zitat Sooklim R, Thinkhamrop J, Lumbiganon P, Prasertcharoensuk W, Pattamadilok J, Seekorn K, Chongsomchai C, Pitak P, Chansamak S (2007) The outcomes of midline versus medio-lateral episiotomy. Reprod Health 4:10PubMedCentralCrossRefPubMed Sooklim R, Thinkhamrop J, Lumbiganon P, Prasertcharoensuk W, Pattamadilok J, Seekorn K, Chongsomchai C, Pitak P, Chansamak S (2007) The outcomes of midline versus medio-lateral episiotomy. Reprod Health 4:10PubMedCentralCrossRefPubMed
73.
Zurück zum Zitat Coats PM, Chan KK, Wilkins M, Beard RJ (1980) A comparison between midline and mediolateral episiotomies. BJOG 87:408–412CrossRef Coats PM, Chan KK, Wilkins M, Beard RJ (1980) A comparison between midline and mediolateral episiotomies. BJOG 87:408–412CrossRef
74.
Zurück zum Zitat El-Din AS, Kamal MM, Amin MA (2014) Comparison between two incision angles of mediolateral episiotomy in primiparous women: a randomised controlled trial. J Obstet Gynaecol Res 40:1877–1882CrossRefPubMed El-Din AS, Kamal MM, Amin MA (2014) Comparison between two incision angles of mediolateral episiotomy in primiparous women: a randomised controlled trial. J Obstet Gynaecol Res 40:1877–1882CrossRefPubMed
75.
Zurück zum Zitat Gonzalez-Díaz E, Moreno Cea L, Fernández Corona A (2015) Trigonometric characteristics of episiotomy and risks for obstetric anal sphincter injuries in operative vaginal delivery. Int Urogynecol J 26:235–242CrossRefPubMed Gonzalez-Díaz E, Moreno Cea L, Fernández Corona A (2015) Trigonometric characteristics of episiotomy and risks for obstetric anal sphincter injuries in operative vaginal delivery. Int Urogynecol J 26:235–242CrossRefPubMed
76.
Zurück zum Zitat Silf K, Woodhead N, Kelly J, Fryer A, Kettle C, Ismail KM (2015) Evaluation of accuracy of mediolateral episiotomy incisions using a training model. Midwifery 31:197–200CrossRefPubMed Silf K, Woodhead N, Kelly J, Fryer A, Kettle C, Ismail KM (2015) Evaluation of accuracy of mediolateral episiotomy incisions using a training model. Midwifery 31:197–200CrossRefPubMed
77.
Zurück zum Zitat Naidu M, Kapoor DS, Evans S, Vinayakarao L, Thakar R, Sultan AH (2015) Cutting an episiotomy at 60 degrees: how good are we? Int Urogynecol J 26:813–816. doi:10.1007/s00192-015-2625-9 Naidu M, Kapoor DS, Evans S, Vinayakarao L, Thakar R, Sultan AH (2015) Cutting an episiotomy at 60 degrees: how good are we? Int Urogynecol J 26:813–816. doi:10.​1007/​s00192-015-2625-9
78.
Zurück zum Zitat Naidu M, Sultan AH, Thakar R (2014) Getting the size right: are gynaecologists ready for it? Int Urogynecol J 25:S86 Naidu M, Sultan AH, Thakar R (2014) Getting the size right: are gynaecologists ready for it? Int Urogynecol J 25:S86
80.
Zurück zum Zitat Naidu M, Sultan AH, Thakar R (2014) Reducing obstetric anal sphincter injuries using perineal support: a preliminary experience. Female Pelvic Med Reconstr Surg 20:S12CrossRef Naidu M, Sultan AH, Thakar R (2014) Reducing obstetric anal sphincter injuries using perineal support: a preliminary experience. Female Pelvic Med Reconstr Surg 20:S12CrossRef
81.
Zurück zum Zitat Johanson RB, Rice C, Doyle M, Arthur J, Anyanwu L, Ibrahim J, Warwick A, Redman CW, O’Brien PM (1993) A randomised prospective study comparing the new vacuum extractor policy with forceps delivery. BJOG 100:524–530CrossRef Johanson RB, Rice C, Doyle M, Arthur J, Anyanwu L, Ibrahim J, Warwick A, Redman CW, O’Brien PM (1993) A randomised prospective study comparing the new vacuum extractor policy with forceps delivery. BJOG 100:524–530CrossRef
82.
Zurück zum Zitat Fitzpatrick M, Behan M, O’Connell PR, O’Herlihy C (2003) Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery. BJOG 110(4):424–429CrossRefPubMed Fitzpatrick M, Behan M, O’Connell PR, O’Herlihy C (2003) Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery. BJOG 110(4):424–429CrossRefPubMed
83.
84.
Zurück zum Zitat Ampt AJ, Ford JB, Roberts CL, Morris JM (2013) Trends in obstetric anal sphincter injuries and associated risk factors for vaginal singleton term births in New South Wales 2001-2009. Aust N Z J Obstet Gynaecol 53(1):9–16CrossRefPubMed Ampt AJ, Ford JB, Roberts CL, Morris JM (2013) Trends in obstetric anal sphincter injuries and associated risk factors for vaginal singleton term births in New South Wales 2001-2009. Aust N Z J Obstet Gynaecol 53(1):9–16CrossRefPubMed
85.
Zurück zum Zitat De Leeuw JW, de Wit C, Kuijken JP, Bruinse HW (2008) Mediolateral episiotomy reduces the risk of anal sphincter injury during operative delivery. BJOG 115:104–108CrossRefPubMed De Leeuw JW, de Wit C, Kuijken JP, Bruinse HW (2008) Mediolateral episiotomy reduces the risk of anal sphincter injury during operative delivery. BJOG 115:104–108CrossRefPubMed
86.
Zurück zum Zitat Murphy DJ, MacLeod M, Bahl R, Strachan B (2011) A cohort of maternal and neonatal morbidity in relation to use of sequential instruments at operative vaginal delivery. Eur J Obstet Gynecol Reprod Biol 156:41–45CrossRefPubMed Murphy DJ, MacLeod M, Bahl R, Strachan B (2011) A cohort of maternal and neonatal morbidity in relation to use of sequential instruments at operative vaginal delivery. Eur J Obstet Gynecol Reprod Biol 156:41–45CrossRefPubMed
87.
Zurück zum Zitat Andrews V, Thakar R, Sultan AH, Kettle C (2005) Can hands-on perineal repair courses affect clinical practice. Br J Midwifery 13(9):562–565CrossRef Andrews V, Thakar R, Sultan AH, Kettle C (2005) Can hands-on perineal repair courses affect clinical practice. Br J Midwifery 13(9):562–565CrossRef
88.
Zurück zum Zitat Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911CrossRefPubMed Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911CrossRefPubMed
89.
Zurück zum Zitat Andrews V, Thakar R, Sultan AH, Jones PW (2006) Occult anal sphincter injuries – myth or reality? BJOG 113:195–200CrossRefPubMed Andrews V, Thakar R, Sultan AH, Jones PW (2006) Occult anal sphincter injuries – myth or reality? BJOG 113:195–200CrossRefPubMed
90.
Zurück zum Zitat Rizk DEE, Thomas L (2000) Relationship between the length of the perineum and position of the anus and vaginal delivery in primigravidae. Int Urogynecol J 11:79–83CrossRef Rizk DEE, Thomas L (2000) Relationship between the length of the perineum and position of the anus and vaginal delivery in primigravidae. Int Urogynecol J 11:79–83CrossRef
Metadaten
Titel
Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions
verfasst von
Dharmesh S. Kapoor
Ranee Thakar
Abdul H. Sultan
Publikationsdatum
01.12.2015
Verlag
Springer London
Erschienen in
International Urogynecology Journal / Ausgabe 12/2015
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-015-2747-0

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