American Journal of Obstetrics & Gynecology
Volume 201, Issue 5 , Pages 526.e1-526.e6, November 2009

Defining an at-risk population for obstetric anal sphincter laceration

Presented at the 35th Annual Scientific Meeting of the Society of Gynecologic Surgeons, New Orleans, LA, March 30-April 1, 2009.

  • Steven M. Minaglia, MD

      Affiliations

    • Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
    • ,
  • Chieko Kimata, PhD, MPH

      Affiliations

    • Department of Patient Safety and Quality, Hawaii Pacific Health, Honolulu, HI
    • ,
  • Karen A. Soules, MD

      Affiliations

    • Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
    • ,
  • Tamara Pappas, BA

      Affiliations

    • Department of Patient Safety and Quality, Hawaii Pacific Health, Honolulu, HI
    • ,
  • Ian A. Oyama, MD

      Affiliations

    • Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI

Received 7 January 2009; received in revised form 31 May 2009; accepted 8 July 2009. published online 18 September 2009.

Objective

The purpose of this study was to calculate the number of cesarean deliveries needed to prevent 1 case of obstetric anal sphincter laceration associated with operative vaginal delivery in an at-risk cohort.

Study Design

An institutional, computerized database was used to analyze women with obstructed labor who could have been managed by either operative vaginal or cesarean delivery from September 2006 to March 2008. Women with 1 or more of the following diagnoses comprised the cohort: cephalopelvic disproportion (CPD), arrest of descent, maternal exhaustion, and fetal distress.

Results

Fifty (23.9%) out of a total of 209 women managed by operative vaginal delivery experienced an anal sphincter laceration compared to none of 254 women in the cesarean delivery group (P < .0001). The ARR therefore was 23.9% (95% confidence interval, 18.1–29.7) and the NNT was 4.2 (95% confidence interval, 3.4–5.5).

Conclusion

Five cesarean deliveries are needed to prevent 1 anal sphincter laceration associated with operative vaginal delivery in this cohort.

Key words: anal sphincter laceration, arrest of descent, cesarean delivery, operative vaginal delivery, pregnancy

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 Cite this article as: Minaglia SM, Kimata C, Soules KA, et al. Defining an at-risk population for obstetric anal sphincter laceration. Am J Obstet Gynecol 2009;201:526.e1-6.

 Reprints not available from the author.

PII: S0002-9378(09)00785-6

doi:10.1016/j.ajog.2009.07.021

American Journal of Obstetrics & Gynecology
Volume 201, Issue 5 , Pages 526.e1-526.e6, November 2009

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