June 30th, 2022

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Obstetric Anal Sphincter Injuries: A Retrospective Observational Analysis of the Duration of Parturition
Authors:  Elliot M. Levine, M.D., Leah N. Delfinado, M.D., Madeleine Durand, M.D., David Rojas, M.D., and Stephen Locher, M.D.
  OBJECTIVE: To investigate the role of the duration of the parturition process in the occurrence of obstetric anal sphincter injuries, in comparison with other known associated factors.

STUDY DESIGN: Observational analysis of consecutive vaginal deliveries, recognizing the incidence of obstetrical anal sphincter injury, and comparing it with the measurement of the duration of parturition from the time of observed crowning until the time of delivery.

RESULTS: The expected association of anal sphincter injury with episiotomy, as well as with operative vaginal delivery, was observed. In addition, an inverse association of the duration of parturition and incidence of sphincter injury was found.

CONCLUSION: The pace of delivery, especially with operative vaginal delivery, may be an important aspect to consider for the conduct of vaginal delivery, paying particular attention to the stretching of the pelvic floor, which typically occurs with crowning at that time. This may help to avoid anal sphincter injury.
Keywords:  delivery, obstetric; duration of parturition; episiotomy; lacerations; obstetric anal sphincter injury; obstetric labor complications; operative vaginal delivery; perineum/injuries; pregnancy; trauma severity indices; vaginal delivery
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