Expertos Invitados





OPINIONES ACTUALES SOBRE LA PREVENCION DE LA INCONTINENCIA ANAL POSPARTO: CESAREA VERSUS PARTO VAGINAL

(especial para SIIC © Derechos reservados)
La incontinencia anal posparto obedece a muchos factores y su alcance, incluidas su frecuencia y gravedad, exige un análisis adecuado para que puedan implementarse estrategias de prevención apropiadas.
lal9.jpg Autor:
Mira Lal
Columnista Experto de SIIC

Institución:
Department of Obstetrics & Gynaecology Russells Hall Hospital

Artículos publicados por Mira Lal
Recepción del artículo
21 de Febrero, 2005 		Aprobación
14 de Febrero, 2005
Primera edición
20 de Enero, 2006 		Segunda edición, ampliada y corregida
7 de Junio, 2021

OPINIONES ACTUALES SOBRE LA PREVENCION DE LA INCONTINENCIA ANAL POSPARTO: CESAREA VERSUS PARTO VAGINAL

Resumen
Los obstetras a veces tienen que considerar si una cesárea electiva puede prevenir la incontinencia anal de las embarazadas sanas. El aumento mundial de las tasas de cesárea afecta la salud reproductiva y la economía de la salud, por lo tanto existe una necesidad de justificar las cesáreas preventivas. La incontinencia anal obedece a muchos factores y su alcance, incluidas su frecuencia y gravedad, exige un análisis adecuado para que puedan implementarse estrategias de prevención. Un estudio llevado a cabo en primíparas (n = 184) sometidas a cesárea y comparadas con mujeres que tuvieron parto normal (n = 100) mostró que los síntomas más graves –que requirieron compresas– ocurrieron en 2 (3%) madres con incontinencia anal luego una cesárea realizada antes del trabajo de parto (n = 80). Este trabajo discute, mediante un enfoque biopsicosocial, los estudios que evalúan la gravedad de los síntomas de la incontinencia anal. Se aplicaron herramientas de evaluación psicosocial que incorporaron la percepción de gravedad por parte de las madres. El impacto físico serio asociado a esta condición acarreó trastornos psicosociales importantes pero otras causas, como las experiencias de parto insatisfactorias, se hicieron relevantes cuando los síntomas se percibieron como menos graves. Las herramientas de evaluación psicosocial posparto orientadas a las pacientes podrían mejorar nuestra comprensión de sus necesidades reales. Otras publicaciones actuales comunican que la incidencia de la incontinencia anal tras la cesárea quizá sea similar o menor a la del parto vaginal. Los síntomas pueden no relacionarse con los resultados anormales de los estudios y pueden resolverse espontáneamente. Las investigaciones de la cesárea preventiva para la incontinencia anal deberían tener en cuenta aquellos factores no relacionados con el trabajo de parto y los aspectos psicosociales.

Palabras clave
Incontinencia anal, incidencia posparto, impacto psicosocial, prevención


Artículo completo
(castellano)
Extensión:  +/-13.25 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

CURRENT THOUGHTS ON THE PREVENTION OF POSTPARTUM ONSET OF ANAL INCONTINENCE: CAESAREAN VS. VAGINAL DELIVERY

Abstract
Obstetricians occasionally have to consider whether an elective caesarean will prevent anal incontinence in a healthy gravida. The global rise in the caesarean rate impinges on reproductive health and health economy, hence, there is a need to justify prophylactic caesarean. Anal incontinence is multifactorial. Its scope including its frequency and severity need adequate assessment for developing preventative strategies. A study investigating primiparae in which caesarean (n = 184) mothers were compared with vaginally delivered (n = 100) reported that severe physical symptoms necessitating pad use occurred in 2 (3%) mothers with anal incontinence following pre-labour caesarean (n = 80). This paper discusses the study’s progress in assessing the severity of these symptoms of anal incontinence using a biopsychosocial approach. Postpartum psychosocial assessment tools which incorporated the mother’s perception of severity were applied. Severe physical burden led to severe psychosocial impairment but other causes, e.g. an unsatisfactory childbirth experience, gained prominence when physical symptoms were perceived as less severe. Assessment using these consumer-orientated postpartum psychosocial evaluation tools would improve our understanding of consumer needs. Other current publications report that frequencies of anal incontinence following caesarean may be similar or lower than that following vaginal delivery. Symptoms may not relate to abnormal investigation results and can resolve spontaneously. Research investigating prophylactic caesarean for preventing anal incontinence should evaluate non-labour factors and the psychosocial aspect.

Key words
Anal incontinence, postpartum incidence, psychosocial impact, prevention


Full text
(english)
 para suscriptores/ assinantes
Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Obstetricia y Ginecología
Relacionadas: Medicina Familiar, Medicina Interna, Salud Mental



Comprar este artículo
Extensión: 13.25 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra




Patrocinio y reconocimiento:
Agradecimientos: Mi sincero reconocimiento a Roger Callender, Teresa Allen y Helen Pattison por su apoyo general y a Bailas Sarhadi y Jane Taylor por su respaldo técnico.
Las figuras 1 a 4 sobre los cambios en el piso y los órganos pelvianos a partir del sexto mes de embarazo son ilustraciones de William Smellie (1852) (cortesía de la Biblioteca William Smellie, Lanarkshire, Reino Unido).
Bibliografía del artículo
  1. Behague DP, Victora CG, Barros FC. Consumer demand for caesarean sections in Brazil: population based birth cohort study linking ethnographic and epidemiological methods. BMJ 2002; 324(7343):942-5.
  2. The National Sentinel Caesarean Section Audit Report. RCOG Press, London, October 2001. pp.1–3.
  3. Murray SF. Relation between private health insurance and high rates of caesarean section in Chile: Qualitative and Quantitative Study. BMJ 2000; 321:1501-5.
  4. Kozak LJ, Weeks JD. U.S. trends in obstetric procedures, 1990-2000. Birth 2002; 29(3):157-61.
  5. Sreevidya S, Sathiyasekaran BWC. High caesarean rates in Madras (India): a population-based cross sectional study. Br J Obstet Gynaecol 2003; 110:106-11.
  6. Hemminki E. Impact of cesarean section on future pregnancy – a review of cohort studies. Paed Perinat Epidemiol 1996; 10:366-79.
  7. Mutryn CS. Psychosocial impact of cesarean section on the family: a literature review. Soc Sci Med 1993; 37(10):271-81.
  8. Sultan AH, Stanton SL. Preserving the pelvic floor and perineum during childbirth – elective caesarean section Br J Obstet Gynaecol 1996; 103:731-4.
  9. Lal M. Prevention of urinary and anal incontinence: role of elective caesarean delivery. Current Opinion Obstet Gynecol 2003; 15(5):439-48.
  10. Lal M, Mann CH, Callender R, Radley S. ‘Does cesarean delivery prevent anal incontinence’ Obstet Gynecol 2003; 2:305-12.
  11. Weber AM, Abrams P, Brubaker L et al. The standardisation of terminology for research in female pelvic floor disorders. Int Urogynecol 2001; 12:178-86.
  12. Thomas TM, Egan M, Walgrove A, Meade TW. The prevalence of faecal and double incontinence. Commun Med 1984; 6:21620.
  13. MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity, and mode of delivery. Br J Obstet Gynaecol 2000; 197:1460-70.
  14. Oakley A. ‘Paradigm of Woman as Reproducer’ in Women Confined Towards a Sociology of Childbirth. Martin Robertson and Company Ltd 1980.
  15. Nygaard IE, Rao SS, Dawson JD. Anal incontinence after anal sphincter disruption: a 30 year retrospective cohort study. Obstet Gynecol 1997; 89:896-901.
  16. Lal M, Pattison HM, Allan TF et al. Severe Psychological & Social consequences of pelvic floor dysfunction in primiparae. Proceedings of the 14th World Congress of the International Society of Psychosomatic Obstetrics and Gynaecology. May 16-19, 2004. pp. 251-5.
  17. Johanson JF, Lafferty J. Epidemiology of fecal incontinence. The silent affliction. Am J Gastroenterol 1996; 91(1):33-6.
  18. Varma A, Gunn J, Gardiner A, Lindow SW, Duthie GS. Obstetric anal sphincteric injury prospective evaluation of incidence. Dis Colon Rectum 1999; 42(12):1537-42.
  19. Chaliha C, Sultan AH, Bland JM et al. Anal function: Effect of pregnancy and delivery. Am J Obstet Gynecol 2001; 185(2):427-32.
  20. Abramowitz L, Sobhani I, Ganansia R, Vuagnat A, Benifla JL, Darai E, Madelenat P, Mignon N. Are sphincter defects the cause of anal incontinence after vaginal delivery Dis Colon Rectum 2000; 43(5):590-8.
  21. Groutz A, Fait JB, Lessing MP et al. Incidence and Obstetric risk factors of postpartum anal incontinence. Scand J Gastroenterol 1999; 3:315-8.
  22. Fornell EKU, Berg G, Hallbook O, Mathieson LS, Sjodahl R. Clinical consequences of anal sphincter rupture during vaginal delivery. J Am Coll Surg 1996; 183:553-8.
  23. Basmajian JV and Sloneck CF. ‘Pelvis and Perineum’ in Grant’s Method of Anatomy. William and Wilkins, 1989. pp. 208-43.
  24. Ganong WF. ‘Defecation’ in Review of medical physiology 18th Edition. Appleton and Lange, Stamford CT, 1997. Chapter 38: p. 477.
  25. Miller R, Bartolo DCC, Cervero F, McC.Mortensen NJ. Anorectal sampling: a comparison of normal and incontinent patients. Br J Surg 1988; 75:44-7.
  26. Schroeder HD, Reske-Nielsen E. Fibre types in the striated urethral and anal sphincters. Acta Neuropathol (Berl) 1983; 60:278-82.
  27. Chamberlain GVP. ‘Early development and embedding of the blastocyst’ in Obstetrics by ten teachers. The Bath Press Avon, 16th Ed.1995. pp. 4-15.
  28. Lansmen HH, Robertson EG. ‘Evolution of the pelvic floor’ in Benson’s Female pelvic floor disorders. WW Norton and Co., 1992. pp. 16-7.
  29. Wall LL, DeLancey JOL. The politics of prolapse: A revisionistic approach to disorders of the pelvic floor in women. Perspectives Biol Med 1991; 34(4):486-96.
  30. Brisinda G. How to treat haemorrhoids. BMJ 2000; 7261:582-3.
  31. Smellie W. A treatise on the theory and practice of midwifery. D Wilson, London, 1852.
  32. MacLennan AH, Nicholson R, Green RC. Serum relaxin levels in pregnancy. Lancet 1986;ii:241-3.
  33. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal sphincter disruption during vaginal delivery. N Eng J Med 1993; 329(26):1905-11.
  34. Fynes M, Donnelly VS, O’Connell R, O’Herlihy C. Cesarean delivery and anal sphincter injury. Obstet Gynecol 1998; 92(4) part 1:496500.
  35. MacArthur C, Bick DE, Keighley MRB. Faecal incontinence after childbirth. Br J Obstet Gynaecol 1997; 104:46-50.
  36. Swash M. Faecal incontinence. Childbirth is responsible for most cases. BMJ 1993; 307:636-7.
  37. Snooks SJ, Swash M, Mathers SE, Henry MM. Effect of vaginal delivery on the pelvic floor: a 5 year follow-up. Br J Surg 1990; 77:1358-60.
  38. Sultan AH, Kamm MA, Bartram CI, Hudson CN. Anal sphincter trauma during instrumental delivery. Int J Gynecol Obstet 1993; 43:26370.
  39. Fitzpatrick M, Behan M, O’Connell R, O’Herlihy C. Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery. Br J Obstet Gynaecol 2003; 110:424-9.
  40. Johanson R, Newburn M. Editorial: Promoting normalcy in childbirth. BMJ. 2001; 323:1142-3.
  41. Johanson RB, Heycock E, Carter J et al. Maternal and child health after assisted vaginal delivery: five year follow-up of a randomized controlled study comparing forceps and ventouse. Br J Obstet Gynaecol 1999; 106:544-9.
  42. Pirhonen JP, Grenman SE, Haadem K et al. Frequency of anal sphincter rupture at delivery in Sweden and Finland; result in difference in manual help to baby’s head. Acta Obstet Gynecol Scand 1998; 77:974-7.
  43. Leeuw JW, Struijk PC, Vierhout ME, Wallenburg HCS. Risk factors for third degree ruptures during delivery. Br J Obstet Gynaecol 2001; 108:383-7.
  44. Sartore A, DeSita F, Maso G et al. The effects of mediolateral episiotomy on pelvic floor function after a vaginal delivery. Obstet Gynecol 2004; 103(4):669-73.
  45. Al-Mufti R, McCarthy A, Fisk N. Obstetricians personal choice and mode of delivery. Lancet 1996; 347:544.
  46. Nygaard I, Cruickshank JP. Editorial. Should all women be offered elective caesarean delivery. Obstet Gynecol 2003; 102(2):217-9.
  47. Bewley S, Cockburn J. II The ‘unfacts’ of ‘request’ caesarean section. Br J Obstet Gynaecol 2002; 109(6):597-605.
  48. Langer A, Viller J. Promoting evidence based practice in maternal care. BMJ 2002; 324:928-9.
  49. Why Mothers Die 2000-2002. The sixth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. RCOG Press, London, 2004.
  50. Lilford RJ, Groot HAVCD, Moore PJ, Bingham P. The relative risks of caesarean section (intrapartum and elective) and vaginal delivery: a detailed analysis to exclude the effects of medical disorders and other acute pre-existing physiological disturbances. Br J Obstet Gynaecol 1990; 97:883-92.
  51. Kastner ES, Figuero AR, Garry D, Maulik D. Emergency peripartum hysterectomy. Experience at a community teaching hospital. Obstet Gynecol 2002; 99:971-5.
  52. O’Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 1996; 175:1632-8.
  53. Flamm BL, Goings JR, Liu Y et al. Elective repeat cesarean delivery versus trial of labour: A prospective multicentre study. Obstet Gynecol 1994; 83(6):927-32.
  54. Brockington I. ‘Preface’ in Motherhood and Mental Health. Oxford University Press, 1998.
  55. Campbell SB, Cohn JF. Prevalence and correlates of postpartum depression in first-time mothers. J Abnormal Psychology 1991; 100(4):394-9.
  56. Murray D, Cox JL, Chapman G, Jones P. Childbirth: Life event or start of a long-term difficulty Br J Psychiat 1995; 166:595-600.
  57. Riley D. ‘Introduction’ in Perinatal mental health. Radcliffe Medical Press 1995.
  58. Oakley A. ‘Paradigm of Woman as Reproducer’ in Women Confined Towards a Sociology of Childbirth. Martin Robertson and Company Ltd 1980.
  59. Gjerdingen DK, Froberg D. Predictors of health in new mothers. Soc Sci Med 1991; 33(12):1399-407.
  60. Tulman L, Fawcett J. Return of functional ability after childbirth. Nursing Research 1988; 37(2):77-81.
  61. Munjack DJ, Ozeil LJ. Sex and pregnancy: part II. Br J Sexual Medicine 1979; 21-2.
  62. Stanton Al, Lobel M, Sears S, Stein DeLuca R. Psychosocial aspects of selected issues in women’s reproductive health: current status and future directions. J Consult Clinic Psychology 2002; 70(3):751-70.
  63. Hiller L, Radley S, Mann CH, Radley SC et al. Development and validation of a questionnaire for the assessment of bowel and urinary tract symptoms in women. Br J Obstet Gynaecol 2002; 109(4):413-23.
  64. Lal M, Pattison HM, Allan TF et al. Postpartum dyspareunia reflects sexual malfunction, pelvic floor and perineal dysfunction: Caesarean vs Vaginal. Proceedings of the 14th World Congress of the International Society of Psychosomatic Obstetrics and Gynaecology. May 16-19th 2004. pp. 267-71.
  65. Lal M, Pattison HM, Allan TF et al. Multiple Post-Caesarean Pelvic floor symptoms and their psychological impact in young primiparae. Published in the Conference handbook of the Biennial Scientific Meeting of the International Marcé Society. 23-26th September 2004 p .
  66. Oakley A. Social consequences of obstetric technology: the importance of measuring “soft” outcomes. Birth 1983; 10(2):99-108.
  67. Bowling A. Research Methods in Health. 2nd Edition. Open University Press 2002:261.
  68. Nazir M, Carlson E, Nescheim B. Do occult anal sphincter injuries, vector volume manometry and delivery variables have any predictive value for bowel symptoms after first time vaginal delivery without 3rd and 4th degree rupture A prospective study. Acta Obstet Gynecol Scand 2002; 81:720-6.
  69. Faridi A, Willis S, Schelzig P, Siggelkow W, Schumpelick V, Rath W. Anal sphincter injury during vaginal delivery – an argument for cesarean section on request Journal of Perinatal Medicine, 2002; 30(5):379-87.
  70. Hannah ME, Hannah WJ, Hodnett ED, Chalmers B, Kung R, William A et al. Outcomes at 3 months after planned caesarean versus planned vaginal delivery for breech presentation at term: The International Randomised Term Breech Trial. JAMA. 2002; 287(4):1822-31.
  71. Thompson JF, Roberts CL, Currie M, Ellwood DA. Prevalence and persistence of health problems after childbirth: associations with parity and method of birth. Birth, 2002; 29(2):83-94.
  72. Ravid A, Richard CS, Spencer LM et al. Pregnancy, delivery, and pouch function after ileal pouch-anal anastomosis for ulcerative colitis. Diseases of the Colon & Rectum, 2002; 45(10):283-8.
  73. Harkin R, Fitzpatrick M, O’Connell PR, O’Herlihy C. anal sphincter disruption at vaginal delivery: is recurrence predictable Eur J Obstet Gynecol Reproductive Biol 2003; 109:149-52.
  74. Bollard RC, Gardiner A, Duthie GS, Lindow SW. Anal sphincter injury faecal and urinary incontinence: a 34 year follow-up after forceps delivery. Dis Colon Rectum 2003; 46(8):1083-8.
  75. Hall W, McCracken K, Oster P, Guise JM. Frequency and predictors of postpartum fecal incontinence. Am J Obstet Gynecol 2003; 88(5):1205-7.
 
 
 
 
 
 
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618
Inicio/Home

Copyright siicsalud © 1997-2024 ISSN siicsalud: 1667-9008