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Abstract
Background: To determine risk factors in cases of third
and fourth degree anal sphincter damage during vaginal
deliveries.
Methods: In this descriptive study all women with
recognized third or fourth degree perineal tear were
included .The main outcome measures were relationship
with parity, weight of baby and mode of delivery.In all
patients end to end anastomosis technique was used to
repair the tear.
Results: A total no of 57(1.8%) were identified to have
sustained anal sphincter complex damage out of 3076
vaginal deliveries. The mean age was 25.65 +_4.6 years.
Majority 52 (91.2%) were between 20-35 years and 3 (5.26%)
> 35years.Most commonly the tears were seen in patients
of reproductive age group. The primipara or primigravidas
had highest frequency of anal sphincter
damage(71.9%).Thirty three (57.9%) had spontaneous
vaginal deliveries (SVD) , 11 (19.3%) SVD with
episiotomy, 11 (19.3%) forceps and 1 (1.75%) vacuum
delivery. Majority (63.16%) delivered babies between 2500-
3500 grams.
Conclusion: Anal sphincter damage is strongly
associated with first vaginal delivery. Forceps delivery as
compared to vacuum delivery has higher rate of third and
fourth degree tears. Mediolateral episiotomy may have
protective role.