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Erschienen in: International Urogynecology Journal 9/2021

18.05.2021 | Original Article

Surgical repair and follow-up of chronic 4th degree obstetric perineal tear (total perineal defect) in 2 centres in eastern Africa

verfasst von: Judith T. W. Goh, Harriet Natukunda, Isaac Singasi, Emma Kabugho, Andrew Browning, Hannah G. Krause

Erschienen in: International Urogynecology Journal | Ausgabe 9/2021

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Abstract

Introduction and hypothesis

Fourth-degree perineal tear occurs in up to 0.2% of vaginal deliveries. In limited resource communities, women often deliver in local villages without facilities to repair obstetric anal sphincter injuries. These fourth-degree tears heal by secondary intention and result in total perineal defects. The aim of the study is to present medium-term follow-up of a large number of women following repair of chronic fourth-degree tear.

Methods

Repairs of chronic obstetric fourth-degree tears were undertaken during surgical camps at Kagando Hospital, Uganda and Selian Hospital, Tanzania, from December 2013 to October 2019. Women completed Cleveland Clinic Incontinence Scores (CCIS) on admission (face to face) and during the 7-year follow-up period (via telephone).

Results

Two hundred fourteen women had medical history and CCIS completed on admission. The mean age at presentation was 33.9 years and mean duration of the condition was 8.9 years. Over a third of women stated they suffered social abandonment because of the unrepaired fourth-degree tear. Nearly 45% of women suffered the tear during the first vaginal delivery. At 1-year follow-up, 87% of 101 women scored 0 (perfect continence) and 94% of 66 women had perfect continence at 2 years. Forty-one births occurred during the follow-up period (32 vaginal deliveries) with two recurrences of fourth-degree tear.

Conclusions

Follow-up in limited resource communities is challenging. Short- to medium-term results of women who had repair of total perineal defect (unrepaired fourth-degree obstetric tears) are encouraging.
Literatur
1.
Zurück zum Zitat Power D, Fitzpatrick M, O’Herlihy C. Obstetric anal sphincter injury: how to avoid, how to repair: a literature review. JFP. 2006;55:193–200. Power D, Fitzpatrick M, O’Herlihy C. Obstetric anal sphincter injury: how to avoid, how to repair: a literature review. JFP. 2006;55:193–200.
2.
Zurück zum Zitat Marsh F, Rogerson L, Landon C, Wright A. Obstetric anal sphincter injury in the UK and its effect on bowel, bladder and sexual function. Eur J Obstet Gynecol Reprod Biol. 2011;154:223–7.CrossRef Marsh F, Rogerson L, Landon C, Wright A. Obstetric anal sphincter injury in the UK and its effect on bowel, bladder and sexual function. Eur J Obstet Gynecol Reprod Biol. 2011;154:223–7.CrossRef
4.
Zurück zum Zitat Kumar R. Anal incontinence and quality of life following obstetric anal sphincter injury. Arch Gynecol Obstet. 2012;285:591–7.CrossRef Kumar R. Anal incontinence and quality of life following obstetric anal sphincter injury. Arch Gynecol Obstet. 2012;285:591–7.CrossRef
5.
Zurück zum Zitat Lindqvist P, Jernetz M. A modified surgical approach to women with obstetric anal sphincter tears by separate suturing of external and internal anal sphincter. A modified approach to obstetric anal sphincter injury. BMC Pregnancy Childbirth. 2010;10:51.CrossRef Lindqvist P, Jernetz M. A modified surgical approach to women with obstetric anal sphincter tears by separate suturing of external and internal anal sphincter. A modified approach to obstetric anal sphincter injury. BMC Pregnancy Childbirth. 2010;10:51.CrossRef
6.
Zurück zum Zitat Ramalingam K, Monga AK. Outcomes and follow-up after obstetric anal sphincter injuries. Int Urogynecol J. 2013;24:1495–500.CrossRef Ramalingam K, Monga AK. Outcomes and follow-up after obstetric anal sphincter injuries. Int Urogynecol J. 2013;24:1495–500.CrossRef
8.
Zurück zum Zitat Hollingshead JRF, Warusavitarne J, Vaisey CJ, Northover JMA. Outcomes following repair of traumatic cloacal deformities. Br J Surg. 2009;96:1082–5.CrossRef Hollingshead JRF, Warusavitarne J, Vaisey CJ, Northover JMA. Outcomes following repair of traumatic cloacal deformities. Br J Surg. 2009;96:1082–5.CrossRef
9.
Zurück zum Zitat Venkatesh KS, Ramanujam P. Surgical treatment of traumatic cloaca. Dis Colon Rectum. 1996;39:811–6.CrossRef Venkatesh KS, Ramanujam P. Surgical treatment of traumatic cloaca. Dis Colon Rectum. 1996;39:811–6.CrossRef
10.
Zurück zum Zitat Abcarian H, Orasy CP, Pearl RK, Nelson RL, Briley SC. Traumatic cloaca. Dis Colon Rectum. 1989;32:783–7.CrossRef Abcarian H, Orasy CP, Pearl RK, Nelson RL, Briley SC. Traumatic cloaca. Dis Colon Rectum. 1989;32:783–7.CrossRef
11.
Zurück zum Zitat Altomare DF, Rinaldi M, Bucaria V, Marino F, Lobascio P, Sallustio PL. Overlapping sphintroplasty and modified lotus petal flap repair of traumatic cloaca. Tech Coloproctol. 2007;11:268–70.CrossRef Altomare DF, Rinaldi M, Bucaria V, Marino F, Lobascio P, Sallustio PL. Overlapping sphintroplasty and modified lotus petal flap repair of traumatic cloaca. Tech Coloproctol. 2007;11:268–70.CrossRef
12.
Zurück zum Zitat Kaiser AM. Cloaca-like deformity with faecal incontinence after severe obstetric injury – technique and functional outcome of ano-vaginal and perineal construction with X-flaps and sphincteroplasty. Color Dis. 2008;10:827–32.CrossRef Kaiser AM. Cloaca-like deformity with faecal incontinence after severe obstetric injury – technique and functional outcome of ano-vaginal and perineal construction with X-flaps and sphincteroplasty. Color Dis. 2008;10:827–32.CrossRef
13.
Zurück zum Zitat Valente MA, Khanduja KS. Layered surgical repair of traumatic cloacal deformities: technical details and functional outcomes. Tech Coloproctol. 2012;16:153–6.CrossRef Valente MA, Khanduja KS. Layered surgical repair of traumatic cloacal deformities: technical details and functional outcomes. Tech Coloproctol. 2012;16:153–6.CrossRef
Metadaten
Titel
Surgical repair and follow-up of chronic 4th degree obstetric perineal tear (total perineal defect) in 2 centres in eastern Africa
verfasst von
Judith T. W. Goh
Harriet Natukunda
Isaac Singasi
Emma Kabugho
Andrew Browning
Hannah G. Krause
Publikationsdatum
18.05.2021
Verlag
Springer International Publishing
Erschienen in
International Urogynecology Journal / Ausgabe 9/2021
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-021-04841-8

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