Original researchObstetric anal sphincter lacerations
Section snippets
Materials and methods
We employed a database of the California Office of State Health Planning and Development, which links California birth certificates to maternal and newborn discharge records since 1992. Ninety-eight percent of all California deliveries are included in the database. Discharge data include diagnostic codes (International Classification of Diseases, 9th Revision) and procedural codes (Current Procedural Terminology). This study was approved by the institutional review boards of the California
Results
The study population included 2,101,843 births. The overall frequency of third- and fourth-degree laceration was 5.85% (123,009 of 2,101,843) (95% CI 5.82, 5.88). The incidence of anal sphincter lacerations decreased significantly over the 6 years of data collection, from 6.35% (95% CI 6.27, 6.43) in 1992 to 5.43% (95% CI 5.35, 5.51) in 1997 (P < .01) (Cochran-Armitage trend test for binomial proportions χ2: 19.38; P < .001; Figure 1).
Table 1 characterizes the study population and summarizes
Discussion
The strength of this study is the size and heterogeneity of the population examined. Prior studies5, 6, 7, 8 have included a relatively small number of cases (276 to 1124 sphincter lacerations), usually from a single institution. The large number of cases in this report (123,009 sphincter lacerations) allows us to simultaneously examine a large number of risk factors. Prior studies found anal sphincter lacerations in 2.2% to 19% of deliveries.5, 6, 7, 8 In our population, 5.85% (95% CI 5.82,
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Asian-White disparities in obstetric anal sphincter injury: a systematic review and meta-analysis
2024, AJOG Global ReportsReducing macrosomia-related birth complications in primigravid women: ultrasound- and magnetic resonance imaging–based models
2023, American Journal of Obstetrics and GynecologyAssociation between birth weight and head circumference and obstetric anal sphincter injury severity
2021, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Several studies have investigated long term complications following OASI and found higher rates of anal incontinence and reduced sphincter tone in major (3c and 4th degree) perineal tears [6–9], while others observed no correlation between the extent of the anal sphincter defect and severity of fecal incontinence [10]. Although previous studies have investigated risk factors for pelvic floor disorders and OASI, such as nulliparity [11–16], operative vaginal delivery [16–21], birth weight (BW) [14–18] and head circumference (HC)[18,22] and presented prediction models for OASI [23], their focus was mostly on the occurrence of OASI as a sole outcome, without a specific evaluation of the anal sphincter tear degree and the unique risk factors for each degree. Few studies have categorized OASI into minor (3a-3b) and major injuries (3c and 4) [24]; however, a paucity of data exists on OASI risk factors with regard to the specific sub-categories of third-degree tear.
Implementation of a perineal support programme for reduction of the incidence of obstetric anal sphincter injuries and the effect of non-compliance
2018, European Journal of Obstetrics and Gynecology and Reproductive BiologyMaternal and neonatal trauma following operative vaginal delivery
2022, CMAJ. Canadian Medical Association Journal