Forceps delivery and complications
The review article by Patel and Murphy gives a concise and clear
overview of the current state of play regarding the use of forceps in
modern obstetric practice. The article addresses the issue of third degree
tears, but does not discuss the occult sphincter injury that may lead to
symptoms later in life. The incidence of endosonographic sphincter damage
following forceps delivery has been reported in 83% of forceps deliveries
when studied prospectively, and this was supported by manometric
abnormalities in these patients (1). Faecal incontinence which develops in
women in later life (age 60-70 years) has been associated with previous
obstetric sphincter injury in 70% of patients, in whom a sphincter defect
can be demonstrated ultrasonongraphically (2).
There is thus a cohort of women who will have an occult sphincter injury
that will only develop symptoms later in life. Women undergoing forceps
delivery should be warned of this possibility.
1. Varma A, Gunn J, Gardiner A, Lindow SW, Duthie GS. Obstetric anal
sphincter injury: prospective evaluation of incidence. Dis Colon Rectum.
2. Oberwalder M, Dinnewitzer A, Baig MK, Thaler K, Cotman K, Nogueras
JJ, Weiss EG, Efron J, Vernava AM 3rd, Wexner SD. The association between
late-onset fecal incontinence and obstetric anal sphincter defects. Arch
Surg. 2004 Apr;139(4):429-32.