Aalders, D. (2024) Consequences of Obstetric Anal Sphincter Lacerations: Delayed Symptom Reporting in Severe Lacerations. An Observational Retrospective cohort study. thesis, Medicine.
Full text available on request.Abstract
Background: Annually, obstetric anal sphincter injuries (OASI) affect approximately 2% of women giving birth in the Netherlands, and are the leading cause of anal incontinence in women. The short- and long-term consequences of OASI remain largely unknown. Objective: The aim is to determine the association between OASI and the mode of delivery and evaluate its short- and long-term consequences. Methods: An observational retrospective cohort study was conducted, including women with a vaginal singleton delivery resulting in OASI between January 1st, 1990, and December 31st, 2015 at Deventer Ziekenhuis or IGO Geboorte Salland. Patient records were reviewed to extract maternal and delivery characteristics, postpartum (six-week) complaints, and follow-up visits. Statistical analysis included T-tests, Mann-Whitney U, Chi-square, and Fisher’s Exact tests. Results: Two hundred fifty-eight women were included in the short-term consequences analyses. Forceps deliveries resulted in OASI in 2.6%, vacuum in 1.2%, and spontaneous deliveries in 1.05%. A significant difference was found between vacuum deliveries and 3a/3b lacerations (26.9%) vs. 3c/4th-degree lacerations (12.0%, P=0.006). Postpartum, 55.4% reported complaints, with flatus incontinence as the most reported complaint (14.3%), especially by 3c/4th-degree lacerations (P=0.051). For the analysis of long-term consequences, 254 women were included. Women with 3a/3b lacerations reported complaints earlier (22.7 months) than women with 3c/4th-degree lacerations (75.8 months), with stress incontinence and dyspareunia as the most reported complaints. Conclusion: Instrumental deliveries, particularly forceps, increase the risk of severe lacerations. Flatus incontinence is the most reported postpartum complaint. Women with 3c/4th-degree lacerations report complaints later than women with type 3a/3b lacerations.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Linden, P.J.Q. van der MD, PhD |
| Faculty: | Medical Sciences |
| Date Deposited: | 19 Sep 2025 11:09 |
| Last Modified: | 19 Sep 2025 11:09 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3823 |
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