Anal sphincters defects following forceps delivery. Part two: usefulness of anal endosonography

Vaginal delivery is a well-known cause of anal incontinence. Several risk factors have been suggested to affect the anal canal muscles, such as: primiparity, high infant birth weight, episiotomy, prolonged first and second stage of labour specially when epidural analgesia was used, malpresentation – occipitoposterior position, and specially the use of forceps and vacuum. Many recent studies have shown that forceps delivery causes anal sphincters injury in more than 60% and even 80% of women. However, new data indicate that this incidence may not be as high, as previously quoted. The first part of this paper discusses various clinical aspects of vaginal delivery complications, including their clinical appearance, reasons of anal incontinence following deliveries, especially with the use of forceps. The second presents applications of endosonography, with its advantages and limitations in the diagnosis of anal incontinence was presented. Importance of anal endosonography was stressed as a main imaging method enabling for diagnosis of obstetric anal sphincters defects, frequently asymptomatic and not coexisting with high-grade peritoneum rupture, as well as planning reconstructive surgery of anal sphincters, including those coexisting with ano- or recto-vaginal fistulas. Opinions on importance of screening of primiparas, especially following forceps delivery and trauma of the peritoneum was presented, as well, in order to diagnose anal sphincters defects and to reduce their further, cumulative trauma in the course of next delivery or proctologic surgery.