Study Type: Intervention

Expected Total Enrollment:

Study Dates:March 2008 -

Anal incontinence is frequent and treatment is difficult. One of the most important reason is traumatic delivery. 10 % of women develop anal incontinence after first delivery. This incidence is higher after second vaginal delivery, particularly if the first delivery had break anal sphincter. One of the possibility to avoid anal incontinence is the caesarean section. So, do we have to recommend caesarean section for second delivery if the first was traumatic. But caesarean section had a morbidity. Actually, the choice between the delivery modalities is very subjective.It seems to be very useful to compare, in randomize control study, global morbidity of caesarean section and vaginal delivery for second delivery if the first had to be traumatic after forceps with anal sphincter rupture diagnosed with anal endosonography. The primary endpoint is comparison of median incontinence score of VAISEY in the two arms after 6 months. The secondary endpoints are urinary incontinence, quality of life and global morbidity between the two arms after second delivery. We estimated, we need 129 women in each arm. Hospital investigators are : BICHAT Claude Bernard (Pr MADELENAT), Rothschild (Pr BENIFLA) and Jean VERDIER (Pr UZAN). Inclusion will be for 2 years and 3 months. Women will be included during the last trimester and evaluation will be perform on 8 weeks, 6 and 12 month after delivery.

Inclusion Criteria:

More than18 years old

having health insurance

Second pregnancy

Inclusion in the third trimester

First delivery was traumatic

No anal incontinence

accept to participate, sign the informed consent- prior medical examination

Exclusion Criteria:

monitoring impossible

woman who have an anal operation

Caesarean section

First delivery with anal break stade 4.

Indication of a scheduled caesarean section not for proctologic reason

Patient physically, mentally or legally incompetent to give informed consent