ABSTRACT
OBJECTIVE: To assess the anal function of women who have suffered a third degree perineal tear during parturition. PATIENTS: Fifty-three consecutive women who sustained a third degree tear, between January 1998 and March 2000, at the Princess Anne Maternity Unit, Royal Bolton Hospital were assessed. METHODS: Women were assessed at 3 months post partum using the Cleveland Clinic Incontinence Score, digital assessment of anal sphincter and endo-anal ultrasound scan. RESULTS: At 3 months post partum 75% of the participants had no symptoms of anal incontinence, 18% had mild symptoms and 7% had more severe symptoms. Anal endosonography demonstrated normal anal sphincters in 66% of participants, an abnormality in the external sphincter in 29% and a defect in both sphincters in 2%. There was poor correlation between symptoms and scan defects. CONCLUSION: The incidence of anal incontinence following repair of a third degree tear was not high and it is unlikely that we are missing a hidden pool of symptomatic women. No major change in management policy is required. The routine assessment of anal function in women who had sustained a third degree tear was appreciated by the women and enabled us to identify the small portion of women with significant symptoms.
Subject(s)
Anal Canal/injuries , Anus Diseases/etiology , Delivery, Obstetric/adverse effects , Anal Canal/diagnostic imaging , Anal Canal/surgery , Digestive System Surgical Procedures/methods , Endosonography/methods , Female , Humans , Recovery of Function , Treatment OutcomeABSTRACT
Both the incidence of twin pregnancy and the demand for prenatal diagnosis are increasing. Unfortunately, biochemical screening and ultrasound scanning are less reliable for prenatal diagnosis in twin pregnancies than in singletons. Amniocentesis and chorionic villous biopsy are usually diagnostic in singleton pregnancies but may be marred by sampling errors in twin gestations. Where a congenital anomaly has been diagnosed in a twin pregnancy, difficult decisions may have to be made, especially if one twin is unaffected. In these cases, special skills are required to ensure that adequate information, psychological support and optimal medical care are provided.
