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Chapter 8 - Previous Third and Fourth Degree Tears

Published online by Cambridge University Press:  14 July 2023

Swati Jha
Affiliation:
Sheffield Teaching Hospital NHS Foundation Trust
Priya Madhuvrata
Affiliation:
Sheffield Teaching Hospital NHS Foundation Trust
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Summary

Consequences of obstetric anal sphincter injuries (OASIs) such as anal incontinence can lead to long-term physical and psychological sequelae. As OASIs occur more frequently in nulliparous women, women will probably present in a subsequent pregnancy. A subsequent delivery can increase the risk of developing or deteriorating anal incontinence symptoms. Therefore, counselling and mode of delivery recommendations should occur in the antenatal period to allow women to make an informed choice about their subsequent delivery. Intrapartum, obstetric practice can be adapted by clinicians, taking into account modifiable risk factors associated with repeat OASIs. However, approaches to prevention of sequelae such as anal incontinence in the long term remains unclear. Conservative options such as pelvic floor muscle training should be encouraged and in cases of intractable symptoms, surgical options are available but these should usually be considered in women who have completed their family.

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Publisher: Cambridge University Press
Print publication year: 2023

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