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Colm Oherlihy - One of the best experts on this subject based on the ideXlab platform.

  • internal Anal sphincter defect influences continence outcome following obstetric Anal sphincter injury
    American Journal of Obstetrics and Gynecology, 2007
    Co-Authors: Rhona Mahony, Colm Oherlihy, Michael Behan, L Daly, Catriona Kirwan, P R Oconnell
    Abstract:

    Objective To date, little correlation has been found between the extent of Anal sphincter injury defined by endoAnal ultrasound and symptoms of postpartum fecal incontinence. To define this relationship, we assessed a large cohort of women following first recognized obstetric Anal sphincter injury. Study design In all, 500 consecutive women were studied at 3 months following primary repair of a first recognized obstetric Anal sphincter injury sustained during vaginal delivery. Assessment included a standardized fecal incontinence questionnaire (modified Jorge-Wexner score), Anal Manometry, and endoAnal ultrasound. Severe fecal incontinence was defined by a score greater than 9. Statistical significance of the relationship between symptoms and factors including age, parity, mode of delivery, and extent of sphincter injury (defined by endoAnal ultrasound), was Analyzed through multiple logistic regression. Results Increasing age ( P = .006) and parity ( P = .039), instrumental delivery ( P P = .047), and internal Anal sphincter (IAS) injury ( P = .002) were significantly related to the presence of fecal incontinence. With multivariate Analysis, and adjusting for other factors, instrumental delivery (OR 3.1; 95% CI 1.2-7.9) and IAS defect thickness (partial thickness defect > 1 quadrant or full thickness defect; OR 5.1 95% CI 1.5-22.9) were predictive of severe incontinence, but external Anal sphincter defects were not. Conclusion Endosonographic evidence of IAS injury is predictive of fecal incontinence following obstetric Anal sphincter injury. The presence of an IAS defect should be sought carefully if the Anal sphincter is injured during vaginal delivery.

  • patterns of abnormal pudendal nerve function that are associated with postpartum fecal incontinence
    American Journal of Obstetrics and Gynecology, 2003
    Co-Authors: Myra Fitzpatrick, Ronan P Oconnell, Conor Obrien, Colm Oherlihy
    Abstract:

    Abstract Objective The purpose of this study was to assess patterns of abnormal pudendal nerve function in women who complain of postpartum fecal incontinence. Study design During a 12-month period, a cohort of 83 women underwent neurophysiologic assessment as part of an evaluation of fecal incontinence after vaginal delivery. Pudendal nerve assessment consisted of the measurement of the clitoral-Anal reflex and quantitative electromyography of the external Anal sphincter. EndoAnal ultrasound examination and Anal Manometry were also performed in each patient. Results Thirty of 83 women (38%) with fecal incontinence were found to have abnormal neurophysiologic condition, among whom four identifiable patterns of abnormality emerged. Five women (17%) had evidence of pudendal nerve demylenation with a prolonged sensory threshold of the clitoral-Anal reflex (>5.2 mA), although electromyography studies were normal. Eight women (27%) had abnormal electromyography results that were consistent with axonal neuropathy with or without reinervation, in whom the clitoral-Anal reflex was normal. Thirteen women (43%) demonstrated a mixed demyelinating and axonal pudendal neuropathy, with evidence of reinervation. Four women (13%) had abnormal patterns of neurophysiologic condition that was not attributable directly to past obstetric trauma but to coincident medical problems. Conclusion Four abnormal patterns of pudendal nerve function may be identified, three of which (demyelinating, axonal, and mixed demyelinating/axonal) can be attributed to specific past obstetric events, although a fourth radicular pattern is due to coincident medical or orthopedic problems. Assessment of pudendal nerve function is important in women with postpartum fecal incontinence because particular patterns of abnormality correlate with different symptoms and can influence treatment options.

  • randomised clinical trial to assess Anal sphincter function following forceps or vacuum assisted vaginal delivery
    British Journal of Obstetrics and Gynaecology, 2003
    Co-Authors: Myra Fitzpatrick, Ronan P Oconnell, Michael Behan, Colm Oherlihy
    Abstract:

    Abstract Objective To compare, in a prospective, randomised controlled trial, differences in Anal sphincter function following forceps or vacuum assisted vaginal delivery in an institution practising standardised management of labour. Design Prospective, randomised controlled trial. Setting Tertiary-referral maternity teaching hospital. Population One hundred and thirty women. Methods Primiparous women were recruited antenatally and if an instrumental delivery was indicated, were randomised to either a vacuum or low-cavity, non-rotational forceps assisted delivery. Follow up consisted of a symptom questionnaire, Anal Manometry and endoAnal ultrasound at three months postpartum. Main outcome measures Faecal continence scores, Anal Manometry, endoAnal ultrasound. Results Sixty-one women delivered with forceps assistance (40 for failure to progress in the second stage) and 69 with vacuum assistance (33 for failure to progress); 16/69 vacuum deliveries proceeded to a forceps assisted delivery (23%). There were no statistical differences in the antecedent antenatal factors between the two groups. A third degree perineal tear followed 10 (16%) forceps and 5 (7%) vacuum deliveries. Based on intention-to-treat Analysis, 36 (59%) women complained of altered faecal continence after forceps delivery compared with 23 (33%) following vacuum delivery three months postpartum (RR 2.88, 95% CI 1.41–5.88). EndoAnal ultrasound was reported as abnormal following 34 (56%) forceps deliveries and 34 (49%) vacuum deliveries (RR 1.3, 95% CI 0.65–258). After exclusion of ‘failed vacuum’, median Anal cAnal resting pressure was significantly lower following forceps delivery compared with vacuum delivery alone (P = 0.004). There were no significant differences in degree of ultrasound abnormality between the two groups. Conclusions Symptoms of altered faecal continence are significantly more common following forceps assisted vaginal delivery. Based on continence outcome, when circumstances allow, vacuum should be the instrument of first choice in assisted delivery.

  • randomised clinical trial to assess Anal sphincter function following forceps or vacuum assisted vaginal delivery
    British Journal of Obstetrics and Gynaecology, 2003
    Co-Authors: Myra Fitzpatrick, Ronan P Oconnell, Michael Behan, Colm Oherlihy
    Abstract:

    Objective To compare, in a prospective, randomised controlled trial, differences in Anal sphincter functionfollowing forceps or vacuum assisted vaginal delivery in an institution practising standardised managementof labour.Design Prospective, randomised controlled trial.Setting Tertiary-referral maternity teaching hospital.Population One hundred and thirty women.Methods Primiparous women were recruited antenatally and if an instrumental delivery was indicated, wererandomised to either a vacuum or low-cavity, non-rotational forceps assisted delivery. Follow up consistedof a symptom questionnaire, Anal Manometry and endoAnal ultrasound at three months postpartum.Main outcome measures Faecal continence scores, Anal Manometry, endoAnal ultrasound.Results Sixty-one women delivered with forceps assistance (40 for failure to progress in the second stage) and69 with vacuum assistance (33 for failure to progress); 16/69 vacuum deliveries proceeded to a forcepsassisted delivery (23%). There were no statistical differences in the antecedent antenatal factors between thetwo groups. A third degree perineal tear followed 10 (16%) forceps and 5 (7%) vacuum deliveries. Based onintention-to-treat Analysis, 36 (59%) women complained of altered faecal continence after forceps deliverycompared with 23 (33%) following vacuum delivery three months postpartum (RR 2.88, 95% CI 1.41–5.88). EndoAnal ultrasound was reported as abnormal following 34 (56%) forceps deliveries and 34 (49%)vacuum deliveries (RR 1.3, 95% CI 0.65–258). After exclusion of ‘failed vacuum’, median Anal cAnalresting pressure was significantly lower following forceps delivery compared with vacuum delivery alone(P ¼ 0.004). There were no significant differences in degree of ultrasound abnormality between the twogroups.Conclusions Symptoms of altered faecal continence are significantly more common following forcepsassisted vaginal delivery. Based on continence outcome, when circumstances allow, vacuum should be theinstrument of first choice in assisted delivery.INTRODUCTIONIn recent years, obstetric morbidity relating to postpar-tum pelvic floor damage and faecal incontinence hasgained increasing attention. Fear of faecal and urinaryincontinence is frequently quoted when women requestelective caesarean section

  • a randomized clinical trial comparing primary overlap with approximation repair of third degree obstetric tears
    American Journal of Obstetrics and Gynecology, 2000
    Co-Authors: Myra Fitzpatrick, Ronan P Oconnell, Michael Behan, Colm Oherlihy
    Abstract:

    Abstract Objective: We compared, in a prospective, randomized clinical trial, the subjective and objective outcomes after primary Anal sphincter overlap or approximation repair of third-degree obstetric tears. Study Design: In a prospective, randomized clinical trial at our university teaching hospital, we studied 112 primiparous women who sustained a third-degree tear during a 1-year period (July 1998–June 1999); they were randomly selected, at diagnosis, to receive either an overlap or an approximation repair. Obstetric personnel, trained in both methods, carried out the repairs immediately after delivery. Fifty-five women underwent an overlap procedure, and 57 women underwent an approximation repair. Outcome measures assessed were symptoms of fecal incontinence, abnormal findings on Anal Manometry, and abnormal findings on endoAnal ultrasonography at 3 months post partum. Results: Obstetric factors, including mode of delivery, birth weight, duration of labor, and episiotomy incidence, did not differ significantly between the 2 groups. Experience of the operator, Analgesia used, and place of repair were similar in both groups. The median incontinence scores were 0/20 after overlap repair and 2/20 after approximation repair (difference not significant). Eleven women (20%) complained of fecal urgency after overlap repair, in comparison with 17 (30%) after approximation repair (difference not significant). There were no significant differences in either Anal Manometry or endoAnal ultrasonographic results between the 2 groups. Six women (11%) had a significant (>1 quadrant) Anal sphincter defect after primary overlap repair, compared with 3 (5%) after approximation repair (difference not significant). Overall, 66% of women had ultrasonographic evidence of a residual full-thickness defect in the external Anal sphincter after primary repair. Conclusion: The outcome after primary repair of third-degree obstetric tear was similar whether an approximation or an overlap technique was used. Overall symptomatic outcome was good, although two thirds of women had ultrasonographic evidence of residual Anal sphincter damage irrespective of the method of repair. (Am J Obstet Gynecol 2000;183:1220-4.)

Abdul H. Sultan - One of the best experts on this subject based on the ideXlab platform.

  • Effect of a subsequent pregnancy on Anal sphincter integrity and function after obstetric Anal sphincter injury (OASI)
    International Urogynecology Journal, 2020
    Co-Authors: Nicola Adanna Okeahialam, Ranee Thakar, Abdul H. Sultan
    Abstract:

    Introduction and hypothesis EndoAnal ultrasound (EAUS) and Anal Manometry are used in the assessment women with a history of obstetric Anal sphincter injury (OASI), both postpartum and in a subsequent pregnancy, to aid counselling regarding mode of delivery (MOD). Methods A prospective observational study between 2012 to 2020 was completed. Women were reviewed 3 months postpartum following OASI and in the second half of a subsequent pregnancy. Anorectal symptoms were measured using the validated St Mark’s Incontinence Score (SMIS: asymptomatic to mild symptoms = ≤ 4). Anal Manometry (incremental maximum squeeze pressure [iMSP: normal = > 20 mmHg]) and EAUS (abnormal = sphincter defect > 1 h in size) were performed. Results One hundred forty-six women were identified and 67.8% had an Anal sphincter defect ≤ 1 h in size postnatally. In those with a defect ≤ 1 h, postpartum mean iMSP and SMIS significantly improved in a subsequent pregnancy ( p  = 0.04 and p  = 0.01, respectively). In women with a defect > 1 h, there was no significant difference between the mean iMSP or SMIS score postnatally compared to a subsequent pregnancy. At both time points, significantly more women had an Anal sphincter defect ≤ 1 h and SMIS of ≤ 4 ( p  = 0.001 and  p  

  • A one-stop perineal clinic: our eleven-year experience
    International Urogynecology Journal, 2020
    Co-Authors: Annika Taithongchai, Abdul H. Sultan, Susana I Veiga, Ranee Thakar
    Abstract:

    Introduction and hypothesis The perineal clinic is a dedicated setting offering assessment for various childbirth-related presentations including obstetric Anal sphincter injuries (OASIs), perineal wound complications, pelvic floor dysfunction and other conditions such as female genital mutilation(FGM). We describe the clinical presentation and outcomes of women from a tertiary perineal clinic based on data collected over an 11-year period. Methods This is a retrospective observational study. A one-stop outpatient service was offered to all women who sustained OASIs (postnatally and antenatally in a subsequent pregnancy), perineal complications (within 16 weeks postpartum), FGM and/or peripartum symptoms of urinary/Anal incontinence or prolapse. Assessment included history with validated questionnaires, examination and Anal Manometry and endoAnal ultrasound when appropriate. Outcomes were compared among different grades of OASIs. Management of each type of presentation was reported with outcomes. Results There were 3254 first attendance episodes between 2006 and 2016. The majority (58.1%) were for OASIs, followed by perineal wound complications. Compared to the lower grades, the higher grades of OASI were associated with poorer outcomes in terms of symptoms, investigations and complications. Women with OASIs had unrelated symptoms such as urinary incontinence, perineal pain and wound infections that needed further intervention. A high proportion(42%) of wound complications required further specialist management. Conclusion We describe a dedicated, one-stop perineal clinic model for antenatal and postnatal women for management of perineal and pelvic floor disorders. This comprehensive and novel data will enable clinicians to better counsel women regarding of outcomes after OASI and focus training to minimize risks of morbidities.

  • the consequences of undiagnosed obstetric Anal sphincter injuries oasis following vaginal delivery
    International Urogynecology Journal, 2020
    Co-Authors: Annika Taithongchai, Abdul H. Sultan, Susana I Veiga, Ranee Thakar
    Abstract:

    We aimed to compare Anal and urinary incontinence symptoms and Anal Manometry between women with undiagnosed obstetric Anal sphincter injuries (OASIS) and women who had OASIS diagnosed and repaired. This was a matched retrospective cohort study. Each missed OASI was matched with a diagnosed OASI for severity [minor (3a/b) or major (3c)], parity and length of follow-up. Women completed the modified St Mark’s Incontinence Score and International Consultation on Incontinence Questionnaire. Women with OASIS or those without OASIS but with Anal incontinence symptoms were seen in perineal clinic for perineal examinations, anorectal Manometry and three-dimensional endoAnal ultrasound 8–12 weeks postnatally or in a subsequent pregnancy. Forty missed OASIS were matched with 40 recognised OASIS (16 3a/b; 24 3c). The median modified St Mark’s scores were higher for missed tears [11 (4, 15) vs. 1 (0, 4), p < 0.001] as well as the urinary incontinence scores [4 (0, 6) vs. 0 (0, 2), p = 0.01] than for the control group. Missed OASIS patients had a shorter perineal body [1.6 ± 1.3 vs. 2.4 ± 0.8, p = 0.009]. All missed OASIS had larger defects on endoAnal ultrasound. One in four missed OASIS required further surgery [aOR 4.1 (95% CI 1.0–16.3), p = 0.04] and almost all needed colorectal input [aOR 24.1 (95% CI 7.3–80.0), p < 0.0001]. There were no differences in Anal Manometry. Women with symptomatic missed OASIS are compromised in terms of Anal and urinary incontinence symptoms, sphincter defect size and perineal body size requiring additional colorectal input. This highlights the importance of preventing OASIS and perseverance with training to diagnose OASIS.

  • effect of subsequent vaginal delivery on bowel symptoms and anorectal function in women who sustained a previous obstetric Anal sphincter injury
    International Urogynecology Journal, 2018
    Co-Authors: Polly A Jordan, Ranee Thakar, Abdul H. Sultan, Madhu Naidu
    Abstract:

    Our primary objective was to prospectively evaluate anorectal symptoms, Anal Manometry and endoAnal ultrasound (EAUS) in women who followed the recommended mode of subsequent delivery following index obstetric Anal sphincter injuries (OASIs) using our unit’s standardised protocol. Our secondary objectives were to evaluate the role of internal Anal sphincter defects and also to compare outcomes in a subgroup of symptomatic women with normal anorectal physiology. This is a prospective follow-up study of pregnant women with previous OASIs who were counselled regarding subsequent mode of delivery between January 2003 and December 2014. Assessment involved the St Mark’s Incontinence Score (SMIS), Anal Manometry and EAUS at both antepartum and 3-month postpartum visits. Data were Analysed using Wilcoxon and Mann–Whitney U tests. Three hundred and fifty women attended the perineal clinic over the study period, of whom 122 met the inclusion criteria (99 vaginal delivery [VD], 23 caesarean section). No significant worsening of anorectal symptoms was observed following subsequent delivery in the VD group (p = 0.896), although a reduced squeeze pressure was observed at 3 months postpartum (p < 0.001). There were no new defects on EAUS in either group. This study showed no significant worsening of bowel symptoms and sphincter integrity apart from lower squeeze pressures at 3 months postpartum in the VD group when our standardised protocol was used to recommend subsequent mode of delivery. In the absence of a randomised study, use of this protocol can aid clinicians in their decision-making.

  • outcome of primary repair of obstetric Anal sphincter injuries oasis does the grade of tear matter
    Ultrasound in Obstetrics & Gynecology, 2010
    Co-Authors: Annemarie Roos, Ranee Thakar, Abdul H. Sultan
    Abstract:

    Objectives To assess risk factors and outcome of different grades of obstetric Anal sphincter injuries (OASIS) after primary repair, and to assess the relationship between outcome of Anal sphincter defects as diagnosed by endoAnal ultrasound. Methods We included 531 consecutive women (of which eight were tertiary referrals) who had sustained OASIS, underwent primary sphincter repair and were followed up between July 2002 and July 2008. At follow-up, defecatory symptoms and bowel-related quality of life (QoL) were evaluated and Anal Manometry and endoAnal ultrasound were performed. Results The mean time of follow-up was 9 (SD, 5.9) weeks after delivery. Compared with women with a minor (Grade 3a/3b) tear, those with a major (Grade 3c/4) one had a significantly poorer outcome (P < 0.05) with respect to the development of defecatory symptoms and associated QoL as well as Anal Manometry. Women with major tears were significantly more likely to have an endosonographic isolated internal Anal sphincter (IAS) or combined IAS and external Anal sphincter (EAS) defect. Combined defects were associated with a higher risk of loose fecal incontinence and lower Anal cAnal pressures. Use of epidural Analgesia was the only independent factor predicting a major tear. Conclusions The greater likelihood of endosonographic Anal sphincter defects in women with major tears compared with minor tears is the probable cause of the less favorable outcome of primary repair. Endosonographic combined defects are associated with poorer outcome and it is therefore important to identify the full extent of injury at delivery in women who sustain OASIS, and to pay particular attention to repair of IAS defects. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.

Ranee Thakar - One of the best experts on this subject based on the ideXlab platform.

  • Effect of a subsequent pregnancy on Anal sphincter integrity and function after obstetric Anal sphincter injury (OASI)
    International Urogynecology Journal, 2020
    Co-Authors: Nicola Adanna Okeahialam, Ranee Thakar, Abdul H. Sultan
    Abstract:

    Introduction and hypothesis EndoAnal ultrasound (EAUS) and Anal Manometry are used in the assessment women with a history of obstetric Anal sphincter injury (OASI), both postpartum and in a subsequent pregnancy, to aid counselling regarding mode of delivery (MOD). Methods A prospective observational study between 2012 to 2020 was completed. Women were reviewed 3 months postpartum following OASI and in the second half of a subsequent pregnancy. Anorectal symptoms were measured using the validated St Mark’s Incontinence Score (SMIS: asymptomatic to mild symptoms = ≤ 4). Anal Manometry (incremental maximum squeeze pressure [iMSP: normal = > 20 mmHg]) and EAUS (abnormal = sphincter defect > 1 h in size) were performed. Results One hundred forty-six women were identified and 67.8% had an Anal sphincter defect ≤ 1 h in size postnatally. In those with a defect ≤ 1 h, postpartum mean iMSP and SMIS significantly improved in a subsequent pregnancy ( p  = 0.04 and p  = 0.01, respectively). In women with a defect > 1 h, there was no significant difference between the mean iMSP or SMIS score postnatally compared to a subsequent pregnancy. At both time points, significantly more women had an Anal sphincter defect ≤ 1 h and SMIS of ≤ 4 ( p  = 0.001 and  p  

  • A one-stop perineal clinic: our eleven-year experience
    International Urogynecology Journal, 2020
    Co-Authors: Annika Taithongchai, Abdul H. Sultan, Susana I Veiga, Ranee Thakar
    Abstract:

    Introduction and hypothesis The perineal clinic is a dedicated setting offering assessment for various childbirth-related presentations including obstetric Anal sphincter injuries (OASIs), perineal wound complications, pelvic floor dysfunction and other conditions such as female genital mutilation(FGM). We describe the clinical presentation and outcomes of women from a tertiary perineal clinic based on data collected over an 11-year period. Methods This is a retrospective observational study. A one-stop outpatient service was offered to all women who sustained OASIs (postnatally and antenatally in a subsequent pregnancy), perineal complications (within 16 weeks postpartum), FGM and/or peripartum symptoms of urinary/Anal incontinence or prolapse. Assessment included history with validated questionnaires, examination and Anal Manometry and endoAnal ultrasound when appropriate. Outcomes were compared among different grades of OASIs. Management of each type of presentation was reported with outcomes. Results There were 3254 first attendance episodes between 2006 and 2016. The majority (58.1%) were for OASIs, followed by perineal wound complications. Compared to the lower grades, the higher grades of OASI were associated with poorer outcomes in terms of symptoms, investigations and complications. Women with OASIs had unrelated symptoms such as urinary incontinence, perineal pain and wound infections that needed further intervention. A high proportion(42%) of wound complications required further specialist management. Conclusion We describe a dedicated, one-stop perineal clinic model for antenatal and postnatal women for management of perineal and pelvic floor disorders. This comprehensive and novel data will enable clinicians to better counsel women regarding of outcomes after OASI and focus training to minimize risks of morbidities.

  • the consequences of undiagnosed obstetric Anal sphincter injuries oasis following vaginal delivery
    International Urogynecology Journal, 2020
    Co-Authors: Annika Taithongchai, Abdul H. Sultan, Susana I Veiga, Ranee Thakar
    Abstract:

    We aimed to compare Anal and urinary incontinence symptoms and Anal Manometry between women with undiagnosed obstetric Anal sphincter injuries (OASIS) and women who had OASIS diagnosed and repaired. This was a matched retrospective cohort study. Each missed OASI was matched with a diagnosed OASI for severity [minor (3a/b) or major (3c)], parity and length of follow-up. Women completed the modified St Mark’s Incontinence Score and International Consultation on Incontinence Questionnaire. Women with OASIS or those without OASIS but with Anal incontinence symptoms were seen in perineal clinic for perineal examinations, anorectal Manometry and three-dimensional endoAnal ultrasound 8–12 weeks postnatally or in a subsequent pregnancy. Forty missed OASIS were matched with 40 recognised OASIS (16 3a/b; 24 3c). The median modified St Mark’s scores were higher for missed tears [11 (4, 15) vs. 1 (0, 4), p < 0.001] as well as the urinary incontinence scores [4 (0, 6) vs. 0 (0, 2), p = 0.01] than for the control group. Missed OASIS patients had a shorter perineal body [1.6 ± 1.3 vs. 2.4 ± 0.8, p = 0.009]. All missed OASIS had larger defects on endoAnal ultrasound. One in four missed OASIS required further surgery [aOR 4.1 (95% CI 1.0–16.3), p = 0.04] and almost all needed colorectal input [aOR 24.1 (95% CI 7.3–80.0), p < 0.0001]. There were no differences in Anal Manometry. Women with symptomatic missed OASIS are compromised in terms of Anal and urinary incontinence symptoms, sphincter defect size and perineal body size requiring additional colorectal input. This highlights the importance of preventing OASIS and perseverance with training to diagnose OASIS.

  • effect of subsequent vaginal delivery on bowel symptoms and anorectal function in women who sustained a previous obstetric Anal sphincter injury
    International Urogynecology Journal, 2018
    Co-Authors: Polly A Jordan, Ranee Thakar, Abdul H. Sultan, Madhu Naidu
    Abstract:

    Our primary objective was to prospectively evaluate anorectal symptoms, Anal Manometry and endoAnal ultrasound (EAUS) in women who followed the recommended mode of subsequent delivery following index obstetric Anal sphincter injuries (OASIs) using our unit’s standardised protocol. Our secondary objectives were to evaluate the role of internal Anal sphincter defects and also to compare outcomes in a subgroup of symptomatic women with normal anorectal physiology. This is a prospective follow-up study of pregnant women with previous OASIs who were counselled regarding subsequent mode of delivery between January 2003 and December 2014. Assessment involved the St Mark’s Incontinence Score (SMIS), Anal Manometry and EAUS at both antepartum and 3-month postpartum visits. Data were Analysed using Wilcoxon and Mann–Whitney U tests. Three hundred and fifty women attended the perineal clinic over the study period, of whom 122 met the inclusion criteria (99 vaginal delivery [VD], 23 caesarean section). No significant worsening of anorectal symptoms was observed following subsequent delivery in the VD group (p = 0.896), although a reduced squeeze pressure was observed at 3 months postpartum (p < 0.001). There were no new defects on EAUS in either group. This study showed no significant worsening of bowel symptoms and sphincter integrity apart from lower squeeze pressures at 3 months postpartum in the VD group when our standardised protocol was used to recommend subsequent mode of delivery. In the absence of a randomised study, use of this protocol can aid clinicians in their decision-making.

  • outcome of primary repair of obstetric Anal sphincter injuries oasis does the grade of tear matter
    Ultrasound in Obstetrics & Gynecology, 2010
    Co-Authors: Annemarie Roos, Ranee Thakar, Abdul H. Sultan
    Abstract:

    Objectives To assess risk factors and outcome of different grades of obstetric Anal sphincter injuries (OASIS) after primary repair, and to assess the relationship between outcome of Anal sphincter defects as diagnosed by endoAnal ultrasound. Methods We included 531 consecutive women (of which eight were tertiary referrals) who had sustained OASIS, underwent primary sphincter repair and were followed up between July 2002 and July 2008. At follow-up, defecatory symptoms and bowel-related quality of life (QoL) were evaluated and Anal Manometry and endoAnal ultrasound were performed. Results The mean time of follow-up was 9 (SD, 5.9) weeks after delivery. Compared with women with a minor (Grade 3a/3b) tear, those with a major (Grade 3c/4) one had a significantly poorer outcome (P < 0.05) with respect to the development of defecatory symptoms and associated QoL as well as Anal Manometry. Women with major tears were significantly more likely to have an endosonographic isolated internal Anal sphincter (IAS) or combined IAS and external Anal sphincter (EAS) defect. Combined defects were associated with a higher risk of loose fecal incontinence and lower Anal cAnal pressures. Use of epidural Analgesia was the only independent factor predicting a major tear. Conclusions The greater likelihood of endosonographic Anal sphincter defects in women with major tears compared with minor tears is the probable cause of the less favorable outcome of primary repair. Endosonographic combined defects are associated with poorer outcome and it is therefore important to identify the full extent of injury at delivery in women who sustain OASIS, and to pay particular attention to repair of IAS defects. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.

Rafael Calpena - One of the best experts on this subject based on the ideXlab platform.

  • effect on Anal pressure of percutaneous posterior tibial nerve stimulation for faecal incontinence
    Colorectal Disease, 2014
    Co-Authors: Alberto Lopezdelgado, Antonio Arroyo, Jaime Ruiztovar, Maria Jose Alcaide, Maria Diez, Pedro Moya, Jair Santos, Rafael Calpena
    Abstract:

    Aim Previous studies on percutaneous posterior tibial nerve stimulation (PTNS) for faecal incontinence do not report Anal pressure changes. In the present study the effect of percutaneous PTNS on Anal Manometry was determined. Method This was a prospective observational study of patients with faecal incontinence. They underwent one 30-min session of PTNS weekly for 12 consecutive weeks. Patients who showed improvement were given six more sessions at 2-weekly intervals. Anal Manometry was performed before and after treatment. Clinical data including the Wexner score, psychological testing, quality of life using the Fecal Incontinence Quality of Life Score and the contents of a continence diary were recorded before and after the procedure. Results Twenty-four patients were included in the study of whom 17 (70.83%) demonstrated some degree of clinical or manometric improvement at 3 months. Before treatment 18 patients had urgency of  12 (P = 0.035). Conclusion Percutaneous PTNS was effective in over 70% of patients in the present study with improvements in urgency, Anal pressures and Wexner score.

Myra Fitzpatrick - One of the best experts on this subject based on the ideXlab platform.

  • patterns of abnormal pudendal nerve function that are associated with postpartum fecal incontinence
    American Journal of Obstetrics and Gynecology, 2003
    Co-Authors: Myra Fitzpatrick, Ronan P Oconnell, Conor Obrien, Colm Oherlihy
    Abstract:

    Abstract Objective The purpose of this study was to assess patterns of abnormal pudendal nerve function in women who complain of postpartum fecal incontinence. Study design During a 12-month period, a cohort of 83 women underwent neurophysiologic assessment as part of an evaluation of fecal incontinence after vaginal delivery. Pudendal nerve assessment consisted of the measurement of the clitoral-Anal reflex and quantitative electromyography of the external Anal sphincter. EndoAnal ultrasound examination and Anal Manometry were also performed in each patient. Results Thirty of 83 women (38%) with fecal incontinence were found to have abnormal neurophysiologic condition, among whom four identifiable patterns of abnormality emerged. Five women (17%) had evidence of pudendal nerve demylenation with a prolonged sensory threshold of the clitoral-Anal reflex (>5.2 mA), although electromyography studies were normal. Eight women (27%) had abnormal electromyography results that were consistent with axonal neuropathy with or without reinervation, in whom the clitoral-Anal reflex was normal. Thirteen women (43%) demonstrated a mixed demyelinating and axonal pudendal neuropathy, with evidence of reinervation. Four women (13%) had abnormal patterns of neurophysiologic condition that was not attributable directly to past obstetric trauma but to coincident medical problems. Conclusion Four abnormal patterns of pudendal nerve function may be identified, three of which (demyelinating, axonal, and mixed demyelinating/axonal) can be attributed to specific past obstetric events, although a fourth radicular pattern is due to coincident medical or orthopedic problems. Assessment of pudendal nerve function is important in women with postpartum fecal incontinence because particular patterns of abnormality correlate with different symptoms and can influence treatment options.

  • randomised clinical trial to assess Anal sphincter function following forceps or vacuum assisted vaginal delivery
    British Journal of Obstetrics and Gynaecology, 2003
    Co-Authors: Myra Fitzpatrick, Ronan P Oconnell, Michael Behan, Colm Oherlihy
    Abstract:

    Abstract Objective To compare, in a prospective, randomised controlled trial, differences in Anal sphincter function following forceps or vacuum assisted vaginal delivery in an institution practising standardised management of labour. Design Prospective, randomised controlled trial. Setting Tertiary-referral maternity teaching hospital. Population One hundred and thirty women. Methods Primiparous women were recruited antenatally and if an instrumental delivery was indicated, were randomised to either a vacuum or low-cavity, non-rotational forceps assisted delivery. Follow up consisted of a symptom questionnaire, Anal Manometry and endoAnal ultrasound at three months postpartum. Main outcome measures Faecal continence scores, Anal Manometry, endoAnal ultrasound. Results Sixty-one women delivered with forceps assistance (40 for failure to progress in the second stage) and 69 with vacuum assistance (33 for failure to progress); 16/69 vacuum deliveries proceeded to a forceps assisted delivery (23%). There were no statistical differences in the antecedent antenatal factors between the two groups. A third degree perineal tear followed 10 (16%) forceps and 5 (7%) vacuum deliveries. Based on intention-to-treat Analysis, 36 (59%) women complained of altered faecal continence after forceps delivery compared with 23 (33%) following vacuum delivery three months postpartum (RR 2.88, 95% CI 1.41–5.88). EndoAnal ultrasound was reported as abnormal following 34 (56%) forceps deliveries and 34 (49%) vacuum deliveries (RR 1.3, 95% CI 0.65–258). After exclusion of ‘failed vacuum’, median Anal cAnal resting pressure was significantly lower following forceps delivery compared with vacuum delivery alone (P = 0.004). There were no significant differences in degree of ultrasound abnormality between the two groups. Conclusions Symptoms of altered faecal continence are significantly more common following forceps assisted vaginal delivery. Based on continence outcome, when circumstances allow, vacuum should be the instrument of first choice in assisted delivery.

  • randomised clinical trial to assess Anal sphincter function following forceps or vacuum assisted vaginal delivery
    British Journal of Obstetrics and Gynaecology, 2003
    Co-Authors: Myra Fitzpatrick, Ronan P Oconnell, Michael Behan, Colm Oherlihy
    Abstract:

    Objective To compare, in a prospective, randomised controlled trial, differences in Anal sphincter functionfollowing forceps or vacuum assisted vaginal delivery in an institution practising standardised managementof labour.Design Prospective, randomised controlled trial.Setting Tertiary-referral maternity teaching hospital.Population One hundred and thirty women.Methods Primiparous women were recruited antenatally and if an instrumental delivery was indicated, wererandomised to either a vacuum or low-cavity, non-rotational forceps assisted delivery. Follow up consistedof a symptom questionnaire, Anal Manometry and endoAnal ultrasound at three months postpartum.Main outcome measures Faecal continence scores, Anal Manometry, endoAnal ultrasound.Results Sixty-one women delivered with forceps assistance (40 for failure to progress in the second stage) and69 with vacuum assistance (33 for failure to progress); 16/69 vacuum deliveries proceeded to a forcepsassisted delivery (23%). There were no statistical differences in the antecedent antenatal factors between thetwo groups. A third degree perineal tear followed 10 (16%) forceps and 5 (7%) vacuum deliveries. Based onintention-to-treat Analysis, 36 (59%) women complained of altered faecal continence after forceps deliverycompared with 23 (33%) following vacuum delivery three months postpartum (RR 2.88, 95% CI 1.41–5.88). EndoAnal ultrasound was reported as abnormal following 34 (56%) forceps deliveries and 34 (49%)vacuum deliveries (RR 1.3, 95% CI 0.65–258). After exclusion of ‘failed vacuum’, median Anal cAnalresting pressure was significantly lower following forceps delivery compared with vacuum delivery alone(P ¼ 0.004). There were no significant differences in degree of ultrasound abnormality between the twogroups.Conclusions Symptoms of altered faecal continence are significantly more common following forcepsassisted vaginal delivery. Based on continence outcome, when circumstances allow, vacuum should be theinstrument of first choice in assisted delivery.INTRODUCTIONIn recent years, obstetric morbidity relating to postpar-tum pelvic floor damage and faecal incontinence hasgained increasing attention. Fear of faecal and urinaryincontinence is frequently quoted when women requestelective caesarean section

  • a randomized clinical trial comparing primary overlap with approximation repair of third degree obstetric tears
    American Journal of Obstetrics and Gynecology, 2000
    Co-Authors: Myra Fitzpatrick, Ronan P Oconnell, Michael Behan, Colm Oherlihy
    Abstract:

    Abstract Objective: We compared, in a prospective, randomized clinical trial, the subjective and objective outcomes after primary Anal sphincter overlap or approximation repair of third-degree obstetric tears. Study Design: In a prospective, randomized clinical trial at our university teaching hospital, we studied 112 primiparous women who sustained a third-degree tear during a 1-year period (July 1998–June 1999); they were randomly selected, at diagnosis, to receive either an overlap or an approximation repair. Obstetric personnel, trained in both methods, carried out the repairs immediately after delivery. Fifty-five women underwent an overlap procedure, and 57 women underwent an approximation repair. Outcome measures assessed were symptoms of fecal incontinence, abnormal findings on Anal Manometry, and abnormal findings on endoAnal ultrasonography at 3 months post partum. Results: Obstetric factors, including mode of delivery, birth weight, duration of labor, and episiotomy incidence, did not differ significantly between the 2 groups. Experience of the operator, Analgesia used, and place of repair were similar in both groups. The median incontinence scores were 0/20 after overlap repair and 2/20 after approximation repair (difference not significant). Eleven women (20%) complained of fecal urgency after overlap repair, in comparison with 17 (30%) after approximation repair (difference not significant). There were no significant differences in either Anal Manometry or endoAnal ultrasonographic results between the 2 groups. Six women (11%) had a significant (>1 quadrant) Anal sphincter defect after primary overlap repair, compared with 3 (5%) after approximation repair (difference not significant). Overall, 66% of women had ultrasonographic evidence of a residual full-thickness defect in the external Anal sphincter after primary repair. Conclusion: The outcome after primary repair of third-degree obstetric tear was similar whether an approximation or an overlap technique was used. Overall symptomatic outcome was good, although two thirds of women had ultrasonographic evidence of residual Anal sphincter damage irrespective of the method of repair. (Am J Obstet Gynecol 2000;183:1220-4.)