Delivery outcomes and events in subsequent pregnancies after previous anal sphincter injury

Ali, Amanda; Glennon, Kate; Kirkham, Colin; Yousif, Seifeldin; Eogan, Maeve

doi:10.1016/j.ejogrb.2013.12.004

Cited by 17 publications

(22 citation statements)

References 9 publications

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“…The incidence of obstetric anal sphincter injuries after vaginal delivery is reported widely ranging from 0.5-11%. 5,10,11,[15][16][17] This paucity of evidence has resulted in a near absence of guidelines from professional bodies. The highest probability of occurrence is related to instrumental delivery, particularly forceps, in the primiparous delivering a neonate in excess of 4 kg in the occiputposterior position.…”

Section: Resultsmentioning

confidence: 99%

“…5,10,15,16,18 The wide variation of obstetric anal sphincter injury prevalence reported elsewhere in the literature 1-4 may be a result of the different population denominators used with some reporting the rate as a proportion of all deliveries and others reporting it as a proportion of only vaginal deliveries. The rate of recurrent obstetric anal sphincter injuries has been widely reported from 3% to 13%.…”

Section: Discussionmentioning

confidence: 99%

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Recurrence of Obstetric Third-Degree and Fourth-Degree Anal Sphincter Injuries

Boggs

Berger

Urquia

et al. 2014

Obstetrics &Amp; Gynecology

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In this study population, the incidence of recurrent obstetric anal sphincter injuries was similar to that of primary obstetric anal sphincter injuries, and most patients went on to deliver vaginally for subsequent deliveries. The risk of recurrent obstetric anal sphincter injuries was doubled in those who delivered a large-for-gestational-age neonate and in those who had an instrumental delivery.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Recurrence of Obstetric Third-Degree and Fourth-Degree Anal Sphincter Injuries

Boggs

Berger

Urquia

et al. 2014

Obstetrics &Amp; Gynecology

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“…Aside from the usual concerns with OASI related to faecal incontinence, perineal pain, dyspareunia, psychological problems, such as depression, and overall impact on quality of life, concerns about recurrence can deter women from having another vaginal delivery [ 8 ] or even from futher childbirth. Reported rates of recurrent OASI (rOASI) are variable, ranging from 2 % [ 9 ] to 13.4 % [ 10 ]; risk factors are poorly reported. A better understanding of the overall risk of recurrence and factors that contribute to that risk would enable women and caregivers to make better informed decisions with regards future childbearing options and mode of delivery.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis

Jha

Parker

2015

Int Urogynecol J

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ObjectivesThe objective of this study was to estimate the risk of recurrent obstetric anal sphincter injury (rOASI) in women who have suffered anal sphincter injury in their previous pregnancy and analyse risk factors for recurrence through a systematic review and meta-analysis.Data sourcesA review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were made in Ovid MEDLINE (1996 to May 2015), PubMed, EMBASE and Google Scholar, including bibliographies and conference proceedings.Methods of study selectionObservational studies (cohort/case–control) evaluating rOASI and risk factors were selected by two reviewers who also analysed methodological quality of those studies. Pooled odds ratios (OR) for rOASI and individual risk factors were calculated using RevMan 5.3.Tabulation, integration and resultsFrom the eight studies assessed, overall risk of rOASI was 6.3 % compared with a 5.7 % risk of OASI in the first pregnancy. The risk in parous women with no previous OASI was 1.5 %. Factors that increased the risk in a future pregnancy were instrumental delivery with forceps [OR 3.12, 95 % confidence interval (CI) 2.42–4.01) or ventouse (OR 2.44, 95 % CI 1.83–3.25), previous fourth-degree tear (OR 1.7, 95 % CI 1.24–2.36) and birth weight ≥4 kg (OR 2.29, 95 % CI 2.06–2.54). Maternal age ≥35 years marginally increased the risk (OR 1.16, 95 % CI 1–1.35).ConclusionThe overall rate of rOASI and associated risk factors for recurrence are similar to the rate and risk factors of primary OASI. Antenatal decisions could be based on assessment of foetal weight and intrapartum decisions based upon the requirement for an instrumental delivery.Electronic supplementary materialThe online version of this article (doi:10.1007/s00192-015-2893-4) contains supplementary material, which is available to authorized users.

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“…With a higher proportion of women experiencing a first OASI, the number at risk of a recurrence in a subsequent birth has in turn increased. The reported recurrence rates vary from 2.0% [ 11 ] to 13.4% [ 12 ], depending on population and study design. Investigation into recurrence risk has generally focussed on factors around the birth subsequent to the OASI, with similar risk factors reported as those for a first OASI [ 7 , 11 - 18 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of first birth obstetric anal sphincter injury on the subsequent birth: a population-based linkage study

Ampt

Roberts

Morris

et al. 2015

BMC Pregnancy Childbirth

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BackgroundWith rising obstetric anal sphincter injury (OASI) rates, the number of women at risk of OASI recurrence is in turn increasing. Decisions regarding mode of subsequent birth following an OASI are complex, and depend on a variety of factors. We sought to identify the risk factors for OASI recurrence from first and subsequent births, and to investigate the effect of OASI birth factors on planned caesarean for the second birth.MethodsUsing two linked population datasets from New South Wales, Australia, we selected women giving birth between 2001 and 2011 with a first birth OASI and a subsequent birth. Multivariable logistic regression was used to identify the association of first and second birth factors with OASI recurrence, and to determine which factors were associated with a planned pre-labour caesarean at the second birth.ResultsOf 6,380 women with a first birth OASI who proceeded to a subsequent birth, 75.4% had a vaginal second birth, 19.4% a pre-labour caesarean, and 5.2% an intrapartum caesarean. Although the OASI recurrence rate of 5.7% was significantly higher than the first birth OASI rate of 4.5% (p < 0.01), this may not reflect a clinically significant increase. Following adjustment for first and second birth factors, first birth diabetes and second birthweight ≥3.5 kg were associated with increased likelihood of OASI recurrence, while first birthweight ≥4.0 kg and second gestation at 37–38 weeks were associated with decreased likelihood. A fourth degree tear at the first birth was the strongest factor associated with planned caesarean at the second birth, with other factors including epidural, spinal or general anaesthetic, birthweight, gestation, country of birth and maternal age.ConclusionsCompared with previous reports, the low OASI recurrence rate (approximately one in twenty) may reflect appropriate decision-making about subsequent mode of delivery following first birth OASI. This assertion is supported by evidence of different risk profiles for women who have planned caesareans compared with planned vaginal births.

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Delivery outcomes and events in subsequent pregnancies after previous anal sphincter injury

Cited by 17 publications

References 9 publications

Recurrence of Obstetric Third-Degree and Fourth-Degree Anal Sphincter Injuries

Recurrence of Obstetric Third-Degree and Fourth-Degree Anal Sphincter Injuries

Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis

The impact of first birth obstetric anal sphincter injury on the subsequent birth: a population-based linkage study

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