Sangalli M R, Floris L, Faltin D, Weil A
Department of Obstetrics and Gynecology, University Hospital of Geneva, Switzerland.
Aust N Z J Obstet Gynaecol. 2000 Aug;40(3):244-8. doi: 10.1111/j.1479-828x.2000.tb03330.x.
We contacted 208 women 13 years after they suffered an obstetrical anal sphincter tear in order to estimate the effect of subsequent vaginal deliveries on anal continence. Among the 177 eligible responders, 129 sustained a partial or complete 3rd degree and 48 a 4th degree tear; 114 women had subsequent vaginal deliveries. Anal incontinence was more common in women with 4th (25.0%) than with 3rd degree tears (11.5%, p = 0.049). Subsequent vaginal deliveries were associated with a higher prevalence of severe incontinence in women with 4th degree tears (p = 0.023). No aggravation or increase in prevalence of incontinence was observed in women with 3rd degree tears. These results suggest that in a subsequent pregnancy, careful evaluation is necessary and an abdominal delivery may be advisable for women with previous major sphincter trauma.
在208名女性发生产科肛门括约肌撕裂13年后，我们与她们取得联系，以评估后续阴道分娩对肛门节制功能的影响。在177名符合条件的应答者中，129人发生部分或完全三度撕裂，48人发生四度撕裂；114名女性随后进行了阴道分娩。四度撕裂的女性中肛门失禁更为常见（25.0%），高于三度撕裂的女性（11.5%，p = 0.049）。四度撕裂的女性中，后续阴道分娩与严重失禁的较高患病率相关（p = 0.023）。三度撕裂的女性未观察到失禁情况加重或患病率增加。这些结果表明，在后续妊娠中，对于有既往严重括约肌创伤的女性，进行仔细评估是必要的，且建议行剖宫产。
