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PWE-408 Should primigravida be made aware of the risk of sphincter injuries and their consequences during antenatal counselling?
  1. M Keighley1,
  2. J Hayes2
  1. 1Colorectal Surgery, BMI Priory Hospital
  2. 2Gastrointestinal Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK


Introduction The incidence of detected third and fourth degree tears is about 2–4%, the risk being higher in first vaginal delivery, assisted deliveries and where there is an abnormal presentation. Many become incontinent.

Method 81 women with faecal incontinence after childhood trauma were interviewed.

Results First vaginal delivery: 68 (84%). Assisted delivery: 57 (70%) (Ventouse alone 11, forceps alone 23, both 23). Third degree tear: 52 (64%) (repaired 27, missed 25). Fourth degree tear: 27 (33%) (repaired 13, missed 14). Neuropathy: 25 (31%). Recto-vaginal fistula: 14 (17%). Episiotomy fistula: 10 (12%). Stoma: 16 (20%) (7 still present). Urinary Incontinence: 42 (52%).

All had severe bowel incontinence.

Sexual dysfunction was present in 77 (95%).

Emotional consequences included: anxiety: 80 (99%), embarrassment: 78 (96%), loss of dignity: 68 (84%), loss of confidence: 68 (84%), feeling isolated: 43 (53%), confined to the house: 24 (30%), antidepressant medication: 31 (38%), anger: 23 (28%).

Conclusion More emphasis should be placed on antenatal counselling, particularly amongst mothers pregnant for the first time.

Disclosure of interest None Declared.

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