Results
A total of 549 women were included, of whom 434 had anal endosonography,
which showed that 264 (60.8%) had anal sphincter lesions. Of these, 222
(84.1%) accepted to be randomized, 112 were assigned to planned VD and
110 to planned CS (Figure 1, Flowchart). Among the 222 randomized women,
20 (9.0%) had third-degree perineal tears during spontaneous VD at the
first delivery and 202 (91.0%) had forceps delivery including 140
(71.1%) without perineal tears and 29 (14.7%) with third-degree
perineal lacerations (table 1). Although according to the eligibility
criteria, none of the women self-reported any anal incontinence symptom
at inclusion, the Vaizey score was calculated during the data analysis
as being ≥5 in 27 women before the second delivery, corresponding to the
definition of symptomatic anal incontinence. The flow chart is reported
in figure 1. Women who did not complete the M6 visit did not differ from
those who completed this visit except for age (see supplementary
appendix).