Regional Pelvic Floor Unit, Department of Gynecology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318, AT, Dordrecht, The Netherlands.
Department of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands.
Int Urogynecol J. 2020 Nov;31(11):2353-2359. doi: 10.1007/s00192-020-04241-4. Epub 2020 Feb 7.
Our primary objective was to evaluate parturition mode (PM) recommendations following obstetric anal sphincter injuries (OASIs) and adherence to these recommendations and to evaluate recurrence of OASIs in women who had a subsequent vaginal delivery (VD). The hypothesis was that adherence to the PM recommendations leads to a reasonable OASI recurrence rate.
This was a retrospective observational cohort study of patients with previous OASIs between 2010 and 2016. After an outpatient visit including 3D transperineal ultrasound to screen for pelvic floor and anal sphincter injuries, all patients received recommendations for a subsequent PM. Patients were invited to complete validated questionnaires 2 to 5 years post-OASIs.
The majority of invited patients (265/320) attended follow-up, with 264 receiving a recommendation for PM. Only 5.6% did not adhere to the received recommendation. One hundred sixty-one patients delivered again, 58% had a VD, and 42% had a cesarean section (CS). Recurrence of OASIs was observed in 4.3% of the patients that had a VD. Fecal incontinence occurred in 4.9%, however any form of anal incontinence in 48% of patients. While dyspareunia was common in patients with residual external anal sphincter (EAS) injuries and levator ani muscle (LAM) avulsions, anal pain occurred more frequently in EAS injuries and fecal incontinence in LAM avulsions.
This study showed that the vast majority of patients followed PM recommendations, and this resulted in a low recurrence of OASIs with a high CS rate. Fecal incontinence after OASIs was correlated with the degree of OASIs.
我们的主要目标是评估产科肛门括约肌损伤（OASI）后分娩方式（PM）的推荐意见以及对这些建议的遵循情况，并评估再次经阴道分娩（VD）的女性 OASI 的复发情况。假设是遵循 PM 推荐意见会导致合理的 OASI 复发率。
这是一项回顾性观察性队列研究，纳入了 2010 年至 2016 年期间患有 OASI 的患者。在包括 3D 经会阴超声筛查盆底和肛门括约肌损伤的门诊就诊后，所有患者均获得了后续 PM 的推荐意见。患者在 OASI 后 2 至 5 年接受了验证后的问卷调查。
大多数受邀患者（265/320）参加了随访，其中 264 名患者接受了 PM 推荐意见。只有 5.6%的患者未遵循建议。161 名患者再次分娩，58%行 VD，42%行剖宫产（CS）。行 VD 的患者中有 4.3%出现 OASI 复发。4.9%的患者出现粪便失禁，但 48%的患者出现任何形式的肛门失禁。虽然在残留的肛门外括约肌（EAS）损伤和肛提肌撕裂的患者中，性交困难较为常见，但 EAS 损伤的患者更常出现肛门疼痛，而 LAM 撕裂的患者更常出现粪便失禁。
本研究表明，绝大多数患者遵循了 PM 推荐意见，这导致 OASI 复发率低且 CS 率高。OASI 后出现粪便失禁与 OASI 的严重程度相关。
