|April 2005 · Vol. 17, No. 4
Anal sphincter injury at childbirth
Immediate or delayed repair? Overlapping or end-to-end technique? Midline or mediolateral episiotomy? Plus: risk factors, and tactics for subsequent deliveries.
Most rectovaginal fistulae occur when physicians fail to recognize the true extent of sphincter injury at the time of repair
Use the episiotomy technique most familiar to you, advises a Cochrane review
Immediate repair of perineal injury is better than delayed repair, to help reduce bleeding and pain
No randomized studies suggest that primary overlap is better than primary end-to-end technique
When to consider vaginal delivery
Specialist Registrar in Obstetrics & Gynecology, Leeds General Infirmary,
Leeds, United Kingdom
There is a crisis of confidence in vaginal delivery. Women are aware of the potential for devastating consequences, and many ask for elective cesarean solely to avoid any possibility of incontinence or other problems linked to vaginal delivery.
Many obstetricians also have misgivings, though they are well aware that a cesarean is far more likely to cause maternal morbidity.1 In a survey of female obstetricians, 31% chose elective cesarean as their preferred mode of delivery—80% of whom gave fear of perineal trauma as their reason.2