Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Original article / research
Year : 2017 | Month : October | Volume : 11 | Issue : 10 | Page : OC18 - OC20

Subclinical Anal Sphincter Injuries Following Instrumental Delivery–A Physiological Analysis: A Pilot Study

Girisha Balaraju, Shiran Shetty, Chandana Seetharama Bhat, Cannanore Ganesh Pai, Deeksha Pandey

1. Associate Professor, Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal. 2. Associate Professor, Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal. 3. Senior Resident, Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Sciences, Jamia University, New Delhi. 4. Professor and Head, Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal. 5. Associate Professor, Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal.

Correspondence Address :
Dr Deeksha Pandey
Kasturba Medical College, Madhav Nagar, Manipal-576104, Udupi Distrcirt. Karnataka.
E-mail: deekshiiiobg@gmail.com

Abstract

Introduction: Obstetric Anal Sphincter Injuries (OASIS) has been reported in up to 25% patients and occult OASIS has been reported in up to 1.2%. Instrumental delivery has been considered a risk factor for OASIS.

Aim: To compare the anal sphincter functions as assessed by Anorectal Manometry (ARM) in asymptomatic patients following instrument delivery with those of patients who underwent Lower Segment Caesarian Section (LSCS) after six months of delivery.

Materials and Methods: Seventeen women who had instrumental delivery and thirteen who underwent elective cesarean section were recruited. Evaluation included a detailed history and physical examination, administration of the Cleveland Clinic Questionnaire and ARM to record the basal pressure, squeeze pressure, anorectal sensation and balloon expulsion time. Categorical variables were compared using the Chi-square test. All calculations were done using the software SPSS 21.0.

Results: We found statistically significant lower basal (34+3.4 vs 60+2.3 mm hg, p<0.05) and squeeze pressures (56+4.1 vs 76+5.2 mm hg, p<0.05), and higher balloon expulsion time (58+2.9 s vs 19+1.8 seconds, p<0.05) in women with instrument delivery compared to LSCS. The rectal sensation was comparable in both the groups.

Conclusion: Persistent subtle anal sphincter dysfunctions are common following instrument delivery compared to LSCS. The role of identifying these and preventing future incontinence in such women needs to be assessed in future studies.

Keywords

Anorectal manometry, Instrumental delivery, Lower segment caesarean section, Obstetric anal sphincter injuries

How to cite this article :

Girisha Balaraju, Shiran Shetty, Chandana Seetharama Bhat, Cannanore Ganesh Pai, Deeksha Pandey. SUBCLINICAL ANAL SPHINCTER INJURIES FOLLOWING INSTRUMENTAL DELIVERY–A PHYSIOLOGICAL ANALYSIS: A PILOT STUDY. Journal of Clinical and Diagnostic Research [serial online] 2017 October [cited: 2018 Jan 24 ]; 11:OC18-OC20. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2017&month=October&volume=11&issue=10&page=OC18-OC20&id=10780

DOI and Others

DOI: 10.7860/JCDR/2017/30484.10780

Date of Submission: May 29, 2017
Date of Peer Review: Jul 28, 2017
Date of Acceptance: Sep 15, 2017
Date of Publishing: Oct 01, 2017

FINANCIAL OR OTHER COMPETING INTERESTS: None.

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