الفهرس Only 14 pages are availabe for public view
 |  | from | 117 |  |  |
| | | from | 117 | | |
Abstract
Perineal trauma or genital tract injury occurs in more than 65% of all vaginal births. It is generally the result of either spontaneous laceration or episiotomy (Kozak et al., 2006). Obstetric anal sphincter injuries (OASI) complicate 0.5-15% of vaginal deliveries and are associated with significant morbidity (Groom and Paterson-Brown, 2002). Several studies have identified a number of obstetric risk factors associated with anal sphincter injury. However, many of the studies in the literature are contradictory (Abimbola et al., 2005). The aim of this study is to evaluate the assumed risk scoring system and to put a cut-off value to detect women at high risk of anal sphincter injury as a first step towards examining safety of vaginal delivery. This prospective study carried on 130 pregnant women attending labour ward for spontaneous vaginal delivery at Ain shams University Maternity hospital from the period of February to May 2009. All patients followed up during labor to detect the presence of the risk factors and a score is given. Data was collected and analyzed using Microsoft Office XP (Excel) and statistical package for social science (SPSS) to detect accuracy for the risk scoring given and to put a cut off value for high and low risk groups. The patients who develop a clinically detected third degree or fourth degree perineal tear were six representing 4.6%. All of them were subjected to immediate repair using overlap technique using vicryl 2/0 and those who had episiotomy were repaired using chromic 0. All patients (whether anal sphincter injury was detected clinically or not) were followed up by phone contact one month later to detect symptoms of incontinence to flatus or stools.Seven ladies suffered from incontinence to flatus one month later representing 5.4%. Only one of them had a clinically detected anal sphincter injury at time of delivery. Total sphincter injury includes both clinically detected injury at time of delivery and occult injuries detected by complain of incontinence to flatus one month later after delivery. They represent 9.2% of the studied group. The results show that there is a negative correlation between maternal age and total sphincter injury. This means the younger the maternal age the higher the risk of anal sphincter injury. The parity has no statistical significant difference as regard anal sphincter injury. However 91.7% of the affected ladies were primipara.The usage of anesthesia is associated with more incidence of anal sphincter injury. Both general and epidural anesthesia show high statistical significant difference as regard total anal sphincter injury. Second stage duration has a statistical significant difference in relation to total anal sphincter injury. The longer the second stage duration the more the risk for anal sphincter injury. 33.3% of the affected group had a second stage duration longer than 60 minutes. Performance of episiotomy especially medio-lateral is associated with increase incidence of anal sphincter injury. 83.3% of the affected ladies had medio-lateral episiotomy done. There is no effect of instrumental delivery as regard anal sphincter injury. This most probably related to low number of instrumental delivery. There is a positive correlation between oxytocin use and total anal sphincter injury. 83.3% of those who had anal sphincter injury used oxytocin for augmentation of labor. There is a positive correlation between score, oxytocin duration of use and total sphincter injury. This means the higher the score the more liability to anal sphincter. The more the duration of use of oxytocin, the more risky the anal sphincter injury. A score of 5 is considered as a cutoff value with sensitivity of 58.3% and a specificity of 61.9%. The probability of having injury at or above the score of 5 is 58.3%. This score can be modified by controlling the modifiable risk factors.