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Anal incontinence after caesarean and vaginal delivery in Sweden: a national population-based study.

https://arctichealth.org/en/permalink/ahliterature299811
Source
Lancet. 2019 Mar 23; 393(10177):1233-1239
Publication Type
Comparative Study
Journal Article
Observational Study
Date
Mar-23-2019
Author
Charlotta Larsson
Charlotta Linder Hedberg
Ewa Lundgren
Lars Söderström
Katarina TunÓn
Pär Nordin
Author Affiliation
Department of Surgical and Perioperative Sciences, University of Umeå and Hospital of Östersund, Östersund, Sweden.
Source
Lancet. 2019 Mar 23; 393(10177):1233-1239
Date
Mar-23-2019
Language
English
Publication Type
Comparative Study
Journal Article
Observational Study
Keywords
Adult
Birth weight
Cesarean Section - adverse effects - methods
Delivery, Obstetric - adverse effects - methods
Fecal Incontinence - diagnosis - epidemiology - etiology
Female
Humans
Male
Maternal Age
Pelvic Floor Disorders - diagnosis - epidemiology - etiology
Pregnancy
Risk factors
Sweden - epidemiology
Abstract
Elective caesarean delivery is increasing rapidly in many countries, and one of the reasons might be that caesarean delivery is widely believed to protect against pelvic floor disorders, including anal incontinence. Previous studies on this issue have been small and with conflicting results. The aim of present study was to compare the risk of developing anal incontinence in women who had a caesarean delivery, in those who had a vaginal delivery, and in two age-matched control groups (nulliparous women and men).
In this observational population-based study, we included all women in the Swedish Medical Birth Register who gave birth by caesarean delivery or vaginal delivery during 1973-2015 in Sweden and were diagnosed with anal incontinence according to ICD 8-10 in the Swedish National Patient Register during 2001-15. Exclusion criteria were multiple birth delivery, mixed vaginal and caesarean delivery, and four or more deliveries. We compared the diagnosis of anal incontinence between women previously delivered solely by caesarean delivery and those who solely had delivered vaginally. We also compared it with two age-matched control groups of nulliparous women and men from the Swedish Total Population Register. Finally, we analysed risk factors for anal incontinence in the caesarean delivery and vaginal delivery groups.
3?755?110 individuals were included in the study. Between 1973 and 2015, 185?219 women had a caesarean delivery only and 1?400?935 delivered vaginally only. 416 (0·22 %) of the 185?219 women in the caesarean delivery group were diagnosed with anal incontinence compared with 5171 (0·37%) of 1?400?935 women in the vaginal delivery group. The odds ratio (OR) for being diagnosed with anal incontinence after vaginal delivery compared with caesarean delivery was 1·65 (95% CI 1·49-1·82; p
Notes
CommentIn: Lancet. 2019 Mar 23;393(10177):1183-1184 PMID 30799058
PubMed ID
30799061 View in PubMed
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Anal incontinence after vaginal delivery: a prospective study in primiparous women.

https://arctichealth.org/en/permalink/ahliterature64062
Source
Br J Obstet Gynaecol. 1999 Apr;106(4):324-30
Publication Type
Article
Date
Apr-1999
Author
J P Zetterström
A. López
B. Anzén
A. Dolk
M. Norman
A. Mellgren
Author Affiliation
Division of Obstetrics and Gynaecology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Source
Br J Obstet Gynaecol. 1999 Apr;106(4):324-30
Date
Apr-1999
Language
English
Publication Type
Article
Keywords
Adult
Anal Canal - injuries
Analysis of Variance
Delivery, Obstetric - adverse effects - methods
Fecal Incontinence - etiology
Female
Flatulence - etiology
Follow-Up Studies
Humans
Maternal Age
Pregnancy
Prospective Studies
Risk factors
Abstract
OBJECTIVE: To investigate the incidence and degree of anal incontinence after vaginal delivery among primiparous women and to define associated risk factors. DESIGN: Prospective observational study. SETTING: Karolinska Institutet, Danderyd Hospital, Sweden, a university hospital. PARTICIPANTS: Three hundred and forty-nine primiparous women. METHODS: Questionnaires distributed within the first days after delivery and re-distributed five and nine months postpartum. Analysis of delivery records. RESULTS: Eighty percent of the women answered all questionnaires. At five months postpartum, 2% of the women had symptoms of faecal incontinence and 25% had symptoms of involuntary flatus. At nine months postpartum, 1% of the women had symptoms of faecal incontinence and 26% had symptoms of involuntary flatus. The majority of the women had infrequent symptoms and a decrease in severity was noted at nine months. Symptoms of incontinence were more common in women who sustained a sphincter tear at delivery. Risk factors for incontinence at five months included maternal age, duration of the second stage of labour, instrumental vaginal delivery, and clinically diagnosed sphincter tear at delivery. Development of incontinence at nine months was associated with maternal age and clinically diagnosed sphincter tear at delivery. CONCLUSIONS: The present study demonstrates that infrequent involuntary flatus is a common symptom after vaginal delivery in primiparous women. These symptoms of involuntary flatus frequently improved and only a few women suffered from frank faecal incontinence. Factors associated with an increased risk of anal incontinence and sphincter tears should be considered during delivery.
Notes
Comment In: Br J Obstet Gynaecol. 1999 Oct;106(10):110710519441
PubMed ID
10426238 View in PubMed
Less detail

Anal sphincter rupture during delivery: philosophy of science and clinical practice.

https://arctichealth.org/en/permalink/ahliterature115013
Source
Tidsskr Nor Laegeforen. 2013 Mar 19;133(6):652-4
Publication Type
Article
Date
Mar-19-2013
Author
Atle Fretheim
Author Affiliation
Global Health Unit, Norwegian Knowledge Centre for the Health Services, Norway. atle.fretheim@kunnskapssenteret.no
Source
Tidsskr Nor Laegeforen. 2013 Mar 19;133(6):652-4
Date
Mar-19-2013
Language
English
Norwegian
Publication Type
Article
Keywords
Anal Canal - injuries
Delivery, Obstetric - adverse effects - methods
Female
Humans
Norway - epidemiology
Obstetric Labor Complications - epidemiology - prevention & control
Perineum
Practice Guidelines as Topic
Pregnancy
Rupture - epidemiology - prevention & control
Notes
Comment In: Tidsskr Nor Laegeforen. 2013 May 28;133(10):1047-823712148
Comment In: Tidsskr Nor Laegeforen. 2013 May 28;133(10):104823712149
PubMed ID
23552161 View in PubMed
Less detail

Anal sphincter tears at spontaneous delivery: a comparison of five hospitals in Norway.

https://arctichealth.org/en/permalink/ahliterature91449
Source
Acta Obstet Gynecol Scand. 2008;87(11):1176-80
Publication Type
Article
Date
2008
Author
Valbø Annelill
Gjessing Leif
Herzog Christine
Goderstad Jeanne Mette
Laine Katariina
Valset Anne Marte
Author Affiliation
Asker and Baerum Hospital, Oslo, Norway. annelill.valbo@sabhf.no
Source
Acta Obstet Gynecol Scand. 2008;87(11):1176-80
Date
2008
Language
English
Publication Type
Article
Keywords
Adult
Anal Canal - injuries
Analgesia, Epidural - methods
Birth weight
Cohort Studies
Delivery, Obstetric - adverse effects - methods
Episiotomy - methods
Female
Gestational Age
Humans
Labor Presentation
Midwifery - methods - standards - statistics & numerical data
Norway
Obstetric Labor Complications
Oxytocin - administration & dosage
Perineum - injuries
Pregnancy
Risk factors
Trauma Severity Indices
Abstract
OBJECTIVE: To analyze circumstances relating to severe anal sphincter tears occurring at spontaneous delivery, in view of reported differences in practice regarding manual perineal protection during delivery. DESIGN: Cohort study of midwife-conducted non-operative vaginal deliveries. SETTING: Five Norwegian hospitals with 12,438 consecutive deliveries during a 12-month period. METHODS: Data from 357 women sustaining third and fourth grade anal sphincter tears (2.9%) were analyzed. MAIN OUTCOME MEASURES: Different incidence of major perineal tears. RESULTS: Sphincter tear incidence varied significantly between the five hospitals, from 1.3 to 4.7% (p
PubMed ID
18972270 View in PubMed
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Are obstetric anal sphincter ruptures preventable?-- large and consistent rupture rate variations between the Nordic countries and between delivery units in Norway.

https://arctichealth.org/en/permalink/ahliterature120162
Source
Acta Obstet Gynecol Scand. 2013 Jan;92(1):94-100
Publication Type
Article
Date
Jan-2013
Author
Katariina Laine
Wenche Rotvold
Anne Cathrine Staff
Author Affiliation
Department of Obstetrics, Oslo University Hospital, Ullevål, Oslo, Norway. kattiksen@yahoo.no
Source
Acta Obstet Gynecol Scand. 2013 Jan;92(1):94-100
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Anal Canal - injuries
Chi-Square Distribution
Delivery, Obstetric - adverse effects - methods
Denmark - epidemiology
Episiotomy - statistics & numerical data
Female
Finland - epidemiology
Humans
Incidence
Norway - epidemiology
Obstetric Labor Complications - epidemiology
Parity
Pregnancy
Registries
Rupture
Sweden - epidemiology
Abstract
To study changes in the incidence of obstetric anal sphincter rupture (OASR) during recent years in Denmark, Finland, Sweden and Norway and hospital-based incidence in recent years in Norway.
Retrospective birth register study.
Unselected population of delivering women in four Nordic countries.
All deliveries (574 175) registered in Denmark, Finland, Norway and Sweden, 2004-2010.
Parity data, including maternal, obstetrical and fetal characteristics, were obtained. The incidence of OASR was calculated from vaginal deliveries. A chi-squared test was used to analyse differences between countries and time periods.
Incidence of OASR.
During the study period, the OASR incidence in Finland was notably lower (0.7-1.0%) than in the other three Nordic countries (4.2-2.3%). A significant and constant reduction in OASR incidence was observed in Norway only (from 4.1 to 2.3%, from 2004 to 2010, p
PubMed ID
23034015 View in PubMed
Less detail

Birth by Caesarean Section and the Risk of Adult Psychosis: A Population-Based Cohort Study.

https://arctichealth.org/en/permalink/ahliterature279444
Source
Schizophr Bull. 2016 May;42(3):633-41
Publication Type
Article
Date
May-2016
Author
Sinéad M O'Neill
Eileen A Curran
Christina Dalman
Louise C Kenny
Patricia M Kearney
Gerard Clarke
John F Cryan
Timothy G Dinan
Ali S Khashan
Source
Schizophr Bull. 2016 May;42(3):633-41
Date
May-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cesarean Section - adverse effects - statistics & numerical data
Cohort Studies
Delivery, Obstetric - adverse effects - statistics & numerical data
Elective Surgical Procedures - adverse effects - statistics & numerical data
Female
Humans
Male
Psychotic Disorders - epidemiology - etiology
Registries
Sweden - epidemiology
Young Adult
Abstract
Despite the biological plausibility of an association between obstetric mode of delivery and psychosis in later life, studies to date have been inconclusive. We assessed the association between mode of delivery and later onset of psychosis in the offspring. A population-based cohort including data from the Swedish National Registers was used. All singleton live births between 1982 and 1995 were identified (n= 1,345,210) and followed-up to diagnosis at age 16 or later. Mode of delivery was categorized as: unassisted vaginal delivery (VD), assisted VD, elective Caesarean section (CS) (before onset of labor), and emergency CS (after onset of labor). Outcomes included any psychosis; nonaffective psychoses (including schizophrenia only) and affective psychoses (including bipolar disorder only and depression with psychosis only). Cox regression analysis was used reporting partially and fully adjusted hazard ratios (HR) with 95% confidence intervals (CI). Sibling-matched Cox regression was performed to adjust for familial confounding factors. In the fully adjusted analyses, elective CS was significantly associated with any psychosis (HR 1.13, 95% CI 1.03, 1.24). Similar findings were found for nonaffective psychoses (HR 1.13, 95% CI 0.99, 1.29) and affective psychoses (HR 1.17, 95% CI 1.05, 1.31) (?(2)for heterogeneityP= .69). In the sibling-matched Cox regression, this association disappeared (HR 1.03, 95% CI 0.78, 1.37). No association was found between assisted VD or emergency CS and psychosis. This study found that elective CS is associated with an increase in offspring psychosis. However, the association did not persist in the sibling-matched analysis, implying the association is likely due to familial confounding by unmeasured factors such as genetics or environment.
Notes
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PubMed ID
26615187 View in PubMed
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Broad-Spectrum Antibiotic Treatment and Subsequent Childhood Type 1 Diabetes: A Nationwide Danish Cohort Study.

https://arctichealth.org/en/permalink/ahliterature284960
Source
PLoS One. 2016;11(8):e0161654
Publication Type
Article
Date
2016
Author
Tine D Clausen
Thomas Bergholt
Olivier Bouaziz
Magnus Arpi
Frank Eriksson
Steen Rasmussen
Niels Keiding
Ellen C Løkkegaard
Source
PLoS One. 2016;11(8):e0161654
Date
2016
Language
English
Publication Type
Article
Keywords
Adolescent
Anti-Bacterial Agents - adverse effects - therapeutic use
Cesarean Section - adverse effects
Child
Child, Preschool
Cohort Studies
Delivery, Obstetric - adverse effects
Denmark
Diabetes Mellitus, Type 1 - epidemiology
Female
Humans
Male
Pregnancy
Proportional Hazards Models
Registries
Abstract
Studies link antibiotic treatment and delivery by cesarean section with increased risk of chronic diseases through changes of the gut-microbiota. We aimed to evaluate the association of broad-spectrum antibiotic treatment during the first two years of life with subsequent onset of childhood type 1 diabetes and the potential effect-modification by mode of delivery.
A Danish nationwide cohort study including all singletons born during 1997-2010. End of follow-up by December 2012. Four national registers provided information on antibiotic redemptions, outcome and confounders. Redemptions of antibiotic prescriptions during the first two years of life was classified into narrow-spectrum or broad-spectrum antibiotics. Children were followed from age two to fourteen, both inclusive. The risk of type 1 diabetes with onset before the age of 15 years was assessed by Cox regression. A total of 858,201 singletons contributed 5,906,069 person-years, during which 1,503 children developed type 1 diabetes.
Redemption of broad-spectrum antibiotics during the first two years of life was associated with an increased rate of type 1 diabetes during the following 13 years of life (HR 1.13; 95% CI 1.02 to 1.25), however, the rate was modified by mode of delivery. Broad-spectrum antibiotics were associated with an increased rate of type 1 diabetes in children delivered by either intrapartum cesarean section (HR 1.70; 95% CI 1.15 to 2.51) or prelabor cesarean section (HR 1.63; 95% CI 1.11 to 2.39), but not in vaginally delivered children. Number needed to harm was 433 and 562, respectively. The association with broad-spectrum antibiotics was not modified by parity, genetic predisposition or maternal redemption of antibiotics during pregnancy or lactation.
Redemption of broad-spectrum antibiotics during infancy is associated with an increased risk of childhood type 1 diabetes in children delivered by cesarean section.
Notes
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PubMed ID
27560963 View in PubMed
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The burden of OASIS increases along with socioeconomic position--register-based analysis of 980,733 births in Finland.

https://arctichealth.org/en/permalink/ahliterature107398
Source
PLoS One. 2013;8(8):e73515
Publication Type
Article
Date
2013
Author
Sari Räisänen
Rufus Cartwright
Mika Gissler
Michael R Kramer
Seppo Heinonen
Author Affiliation
Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland.
Source
PLoS One. 2013;8(8):e73515
Date
2013
Language
English
Publication Type
Article
Keywords
Anal Canal - injuries
Delivery, Obstetric - adverse effects
Fecal Incontinence - epidemiology - etiology
Female
Finland
Humans
Male
Postoperative Complications - epidemiology
Registries
Retrospective Studies
Risk factors
Socioeconomic Factors
Abstract
Obstetric anal sphincter injury (OASIS) has been identified as a major preventable risk factor for anal incontinence.
Aim was to measure national variation in incidence of OASIS by socioeconomic status (SES).
A retrospective population based case-control study using the data derived from the Finnish Medical Birth Register for the years 1991-2010. A total population of singleton vaginal births was reviewed. We calculated unadjusted incidences of OASIS stratified by SES and vaginal parity, and adjusted risks for OASIS in each social class, after controlling for parity, birthweight, mode of delivery, maternal age and maternal smoking. SES was recorded into five categories based on mother's occupation at time of birth; upper white-collar workers such as physicians, lower white-collar workers such as nurses, blue-collar workers such as cleaners, others such as students, and cases with missing information.
Seven per thousand (6,404 of 980,733) singleton births were affected by OASIS. In nulliparae the incidence of OASIS was 18% higher (adjusted OR 1.18 95% CI 1.04-1.34) for upper white-collar workers and 12% higher (adjusted OR 1.12 95% CI 1.02-1.24) for lower white-collar workers compared with blue-collar workers. Among women in these higher SES groups, 40% of the excess OASIS risk was explained by age, non-smoking, birthweight and mode of delivery. Despite the large effect of SES on OASIS, inclusion of SES in multivariable models caused only small changes in estimated adjusted effects for other established risk factors.
OASIS at the first vaginal delivery demonstrates a strong positive social gradient. Higher SES is associated with a number of risk factors for OASIS, including higher birthweight and non-smoking, but only 40% of the excess incidence is explained by these known risk factors. Further research should address other underlying causes including differences in lifestyle or environmental factors, and inequalities in healthcare provision.
Notes
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PubMed ID
24013645 View in PubMed
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Changing incidence of anal sphincter tears in four Nordic countries through the last decades.

https://arctichealth.org/en/permalink/ahliterature95231
Source
Eur J Obstet Gynecol Reprod Biol. 2009 Sep;146(1):71-5
Publication Type
Article
Date
Sep-2009
Author
Laine Katariina
Gissler Mika
Pirhonen Jouko
Author Affiliation
Oslo University Hospital, Ullevål, Department of Obstetrics and Gynecology, Kirkeveien 166, 0407 Oslo, Norway. kattiksen@yahoo.no
Source
Eur J Obstet Gynecol Reprod Biol. 2009 Sep;146(1):71-5
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Adult
Anal Canal - injuries
Delivery, Obstetric - adverse effects - methods
Denmark - epidemiology
Episiotomy - adverse effects
Female
Finland - epidemiology
Humans
Incidence
Lacerations - complications - epidemiology
Norway - epidemiology
Obstetric Labor Complications - epidemiology
Pregnancy
Registries
Sweden - epidemiology
Abstract
OBJECTIVES: Anal sphincter rupture is a serious complication of a vaginal delivery. A considerable number of women suffer permanent anal incontinence after this type of injury. The incidence of sphincter tears is believed to have increased over several decades in Denmark, Norway, Sweden and Finland, but there seem to be significant differences in the incidence rates among these countries. The aim of this study is to compare frequency of anal sphincter tears among the four Nordic countries, and to discuss the possible reasons for the development. STUDY DESIGN: Ecological register study. Anal sphincter ruptures are registered as third and fourth degree perineal tears in the national birth and hospital registries in the Nordic countries. Data from these registries were sampled from Denmark, Finland, Norway and Sweden. The incidences of anal sphincter ruptures were calculated as percentages of all vaginal deliveries and caesarean sections were excluded. The test of relative proportions, Chi-square and linear regression modelling were used to study the difference between countries and time trends. RESULTS: The frequency of anal sphincter rupture was significantly higher in three countries, Denmark 3.6%, Norway 4.1% and Sweden 4.2%, compared to Finland 0.6%. The trend was clearly increasing from the early 1970s in all countries. CONCLUSIONS: There is a significant difference in the Nordic countries in the incidence of anal sphincter tears and a significant increment in the incidence over three decades. Our hypothesis is that change in the routines during labour may be one reason for this increment. Higher episiotomy frequency in Finland may be one contributing reason. We assume that there has been a change in the conduct of labour during the last decades, and protecting the perineum may have lost its importance in the three Nordic countries, while the classic method of protecting perineum is still in use in Finland.
PubMed ID
19482405 View in PubMed
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