{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:24:29Z","timestamp":1792038269062,"version":"4.4.0"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,5,4]],"date-time":"2018-05-04T00:00:00Z","timestamp":1525392000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To establish the prevalence of external (EAS) and internal (IAS) anal sphincter defects present 15\u201324\u2009years after childbirth according to mode of delivery, and their association with development of fecal incontinence (FI). The study additionally aimed to compare the proportion of women with obstetric anal sphincter injuries (OASIS) reported at delivery with the proportion of women with sphincter defect detected on ultrasound 15\u201324\u2009years later.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a cross\u2010sectional study including 563 women who delivered their first child between 1990 and 1997. Women responded to a validated questionnaire (Pelvic Floor Distress Inventory) in 2013\u20132014, from which the proportion of women with FI was recorded. Information about OASIS was obtained from the National Birth Registry. Study participants underwent four\u2010dimensional transperineal ultrasound examination. Defect of EAS or IAS of \u2265\u200930\u00b0 in at least four of six slices on tomographic ultrasound was considered a significant defect and was recorded. Four study groups were defined based on mode of delivery of the first child. Women who had delivered only by Cesarean section (CS) constituted the CS group. Women in the normal vaginal delivery (NVD) group had NVD of their first child and subsequent deliveries could be NVD or CS. The forceps delivery (FD) group included women who had FD, NVD or CS after FD of their first born. The vacuum delivery (VD) group included women who had VD, NVD or CS after VD of their first born. Multiple logistic regression was used to calculate adjusted odds ratios (aORs) for comparison of prevalence of an EAS defect following different modes of delivery and to test its association with FI. Fisher's exact test was used to calculate crude odds ratios (ORs) for IAS defects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Defects of EAS and IAS were found after NVD (<jats:italic>n<\/jats:italic>\u2009=\u2009201) in 10% and 1% of cases, respectively, after FD (<jats:italic>n<\/jats:italic>\u2009=\u2009144) in 32% and 7% of cases and after VD (<jats:italic>n<\/jats:italic>\u2009=\u2009120) in 15% and 4% of cases. No defects were found after CS (<jats:italic>n<\/jats:italic>\u2009=\u200998). FD was associated with increased risk of EAS defect compared with NVD (aOR\u2009=\u20093.6; 95% CI, 2.0\u20136.6) and VD (aOR\u2009=\u20093.0; 95% CI, 1.6\u20135.6) and with increased risk of IAS defect compared with NVD (OR\u2009=\u20097.4; 95% CI, 1.5\u201370.5). The difference between VD and NVD was not significant for EAS or IAS. FI was reported in 18% of women with an EAS defect, in 29% with an IAS defect and in 8% without a sphincter defect. EAS and IAS defects were associated with increased risk of FI (aOR\u2009=\u20092.5 (95% CI, 1.3\u20134.9) and OR\u2009=\u20094.2 (95% CI, 1.1\u201313.5), respectively). Of the ultrasonographic sphincter defects, 80% were not reported as OASIS at first or subsequent deliveries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Anal sphincter defects visualized on transperineal ultrasound 15\u201324\u2009years after first delivery were associated with FD and development of FI. Ultrasound revealed a high proportion of sphincter defects that were not recorded as OASIS at delivery. Copyright \u00a9 2017 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.18827","type":"journal-article","created":{"date-parts":[[2017,8,7]],"date-time":"2017-08-07T04:02:38Z","timestamp":1502078558000},"page":"677-683","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Anal sphincter defects and fecal incontinence 15\u201324 years after first delivery: a cross\u2010sectional study"],"prefix":"10.1002","volume":"51","author":[{"given":"R. A.","family":"Guzm\u00e1n Rojas","sequence":"first","affiliation":[{"name":"Departamento de Ginecolog\u00eda y Obstetricia, Facultad de Medicina Cl\u00ednica Alemana \u2010 Universidad del Desarrollo  Santiago Chile"},{"name":"Departamento de Ginecolog\u00eda y Obstetricia Hospital Cl\u00ednico de la Universidad de Chile  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. \u00c5.","family":"Salvesen","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine Norwegian University of Science and Technology  Trondheim Norway"},{"name":"Department of Obstetrics and Gynaecology Trondheim University Hospital, Trondheim  Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9392-1674","authenticated-orcid":false,"given":"I.","family":"Voll\u00f8yhaug","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine Norwegian University of Science and Technology  Trondheim Norway"},{"name":"Department of Obstetrics and Gynaecology Trondheim University Hospital, Trondheim  Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,5,4]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2003.10.013"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.308.6933.887"},{"key":"e_1_2_6_4_1","first-page":"326","article-title":"Anal incontinence after childbirth","volume":"166","author":"Eason E","year":"2002","journal-title":"CMAJ"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2007.01445.x"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12898"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0593-0"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000057"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-001257"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.04.033"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181e2f50b"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12363"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2001.00090.x"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7227.86"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/0020-7292(93)90514-W"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13224-012-0282-1"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2000.tb03330.x"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01502.x"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000147597.45349.e8"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.04.054"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00400.x"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199312233292601"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12481"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00799.x"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/27314678"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1997.tb12056.x"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e318251dca1"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13368"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.10072"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14891"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13322"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14845"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7512"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(98)00017-4"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000165273.68486.95"}],"container-title":["Ultrasound in Obstetrics &amp; 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