Authors: S E Schraffordt Koops H A M Vervest H J M Oostvogel
Publish Date: 2003/08/01
Volume: 14, Issue: 4, Pages: 244-249
Abstract
The aim of this study was to determine the prevalence of and the changes in anorectal symptoms following different modes of vaginal delivery in primiparous women Six hundred and seventeen questionnaires were distributed to primiparous women 3–4 years after delivery The questionnaires were designed to obtain information regarding the development of anorectal symptoms including the type of symptoms experienced their severity and their impact on lifestyle A total of 479 questionnaires were returned representing a response rate of 776 Women included in the study were divided into three groups on the basis of the mode of delivery normal vaginal vacuum extraction and forceps Any episode of fecal incontinence was considered to be abnormal Following delivery de novo incontinence developed in 22 There was no significant difference between the three modes of vaginal delivery in terms of the development of fecal incontinence normal vaginal delivery 22 vacuum extraction 20 forceps delivery 26 Furthermore analysis of obstetric variables could not identify one significant independent risk factor for anorectal incontinence The results of this study suggest that instrumental vaginal deliveries are as safe as a normal vaginal delivery in terms of the development of anorectal symptomsEditorial Comment This is a wellwritten article that addresses an important issue in obstetrics and gynecology ie the likely consequences of defective anal sphincter function after pregnancy and delivery As the authors emphasize the article suffers from the fact that this was a retrospective study Furthermore it would have been very interesting to know the differences between patients undergoing cesarean section and those giving birth vaginally In two recently published investigations there were no differences between cesarean section and normal vaginal delivery in terms of fecal and urinary incontinence post partum We still do not know how to identify patients who are at risk of developing incontinence after pregnancy and delivery
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