It is now recognized that 35% of women undergoing their first vaginal delivery develop anal sphincter injury [10,11]. Approximately 10% will still have anal symptoms of urgency or incontinence at 3 months post-natal. Again, in the 6-year follow-up study by Glazener et al. , there was no improvement in this anal incontinence rate over time and at 6 years the faecal incontinence rate actually increased to 13%. The aetiology of this type of anal sphincter trauma is complex in the same way as the mechanisms that maintain continence are complex. Instrumental delivery is a recognized cause of trauma and randomized trials suggest that the use of the vacuum extractor is associated with less perineal trauma than forceps delivery [12,13]. In looking at the incidence of anal incontinence, forceps delivery gave a 32% incidence versus 16% for vacuum extraction. The incidence of third and fourth degree tears varies enormously from centre to centre suggesting the clinical ability to recognize this type of trauma may vary. In those women who have a recognized anal sphincter rupture, 37% continue to have anal incontinence despite primary sphincter repair .
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.