A systematic review of 48 cases of vaginal delivery with rectal buttonhole tears
10.3760/cma.j.cn113903-20240220-00121
- VernacularTitle:阴道分娩直肠扣眼裂伤48例分析：系统综述
- Author:
Sisi XI
1
;
Weijie SUN
;
Huixia YANG
Author Information
1. 北京大学第一医院妇产生殖医学中心，北京 100034
- Keywords:
Rectal buttonhole tear;
Rectal laceration;
Soft birth canal laceration;
Delivery;
Complication
- From:
Chinese Journal of Perinatal Medicine
2024;27(11):893-898
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To review the literature and summarize the clinical characteristics and treatment methods of rectal buttonhole tears associated with vaginal delivery.Methods:Using the keywords "rectal tear and delivery" "rectal laceration and delivery" "rectal lesion and delivery", and "rectal buttonhole tear", we conducted a search for Chinese-language papers published on the Yiigle, CNKI (China National Knowledge Infrastructure), Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Service Platform. Additionally, using the same keywords in English, we searched for papers published on PubMed and Embase. The search period covers from the establishment of the databases up to November 15, 2023. Cases with a clear diagnosis of rectal buttonhole tears associated with vaginal delivery were included. Data on maternal age, parity, gestational weeks, neonatal birth weight, time of rectal tear discovery, whether episiotomy was performed, whether instrumental delivery was used, details of the rectal tear, management after discovering the tear, and prognosis were analyzed. Descriptive statistical analysis was used.Results:A total of 30 papers were included, published from 1952 to 2023, encompassing 48 cases of vaginal delivery with rectal buttonhole tears. (1) Age and parity: The median age of patients was 28.0 years (range 21-44 years), with primiparas and multiparas accounting for 72.5% (29/40) and 27.5% (11/40), respectively. (2) Gestational weeks: The median gestational age at delivery was 39.0 weeks (range 36.0-41.0 weeks). (3) Neonatal birth weight: The median birth weight of the neonates was 3 595 g (range 2 320-4 250 g), with four cases of macrosomia (birth weight≥4 000 g), accounting for 9.5% (4/42) of singleton births. (4) Time at identification of rectal buttonhole tear: Rectal tears were discovered before fetal delivery in 26.7% (12/45) of cases and after delivery in 73.3% (33/45) of cases. (5) Location: Rectal buttonhole tears most commonly occurred at the midline of the posterior vaginal wall (65.6%, 21/32), followed by the right side of the episiotomy wound (12.5%, 4/32). (6) Relationship between rectal buttonhole tears and delivery mode: Rectal buttonhole tears can occur in spontaneous vaginal delivery, episiotomy, and instrumental vaginal delivery. They may occur during the first or second stage of labor. (7) Timing of rectal tear suturing and prognosis: 93.4% (45/48) of patients underwent primary rectal suturing, among whom, 93.3% (42/45) had good healing, while 6.7% (3/45) developed rectovaginal fistula postoperatively.Conclusions:Rectal buttonhole tear is a rare complication of vaginal delivery and should be recognized. If identified promptly and repaired with primary suturing, the prognosis is generally favorable.
