Anal sphincter disruption at vaginal delivery: is recurrence predictable?

Eur J Obstet Gynecol Reprod Biol. 2003 Aug 15;109(2):149-52. doi: 10.1016/s0301-2115(03)00008-3.


Objective: We prospectively evaluated the risk of recurrence of anal sphincter disruption ("third degree tear") at next vaginal delivery and whether this complication was predictable by antepartum anal functional assessment.

Study design: Among 20,111 consecutive vaginal deliveries, where midline episiotomy was not performed, 342 (1.7%) third degree tears occurred, significantly more often in primiparae (2.9%) than multiparae (0.8%; P<0.001), all of whom underwent postpartum anal manometry and endosonography. Similar testing was performed antepartum and postpartum in 56 of 342 women who delivered again during the study period.

Results: Eleven of 56 women were delivered by caesarean in next pregnancy. Third degree tears recurred in 2 (4.4%) of 45 women at next vaginal delivery. Both recurrent injuries occurred in asymptomatic women with normal antepartum manometry and following spontaneous deliveries and were satisfactorily repaired.

Conclusion: Although anal sphincter injury was increased five-fold at next delivery, compared with all multiparae, 95% of women delivering vaginally after previous third degree tear did not sustain further overt sphincter damage. Recurrence was not predictable using pre-delivery anal physiology testing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anal Canal / injuries*
  • Comorbidity
  • Delivery, Obstetric*
  • Fecal Incontinence / epidemiology
  • Fecal Incontinence / prevention & control
  • Female
  • Humans
  • Incidence
  • Ireland / epidemiology
  • Obstetric Labor Complications / epidemiology
  • Obstetric Labor Complications / prevention & control*
  • Parity
  • Pregnancy
  • Prospective Studies
  • Puerperal Disorders / epidemiology
  • Puerperal Disorders / prevention & control*
  • Secondary Prevention