Obstetric anal sphincter injuries—Maternal, fetal and sociodemographic risk factors: A retrospective register‐based study

André, Kristin; Stuart, Andrea; Källén, Karin

doi:10.1111/aogs.14425

Cited by 8 publications

(4 citation statements)

References 31 publications

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“…We also did not retrieve the number of prostaglandins used in cases of adverse outcomes. Obstetric sphincter injury (OASIS) was not explored in our study; previous cesarean section increases the risk of OASIS [ 51 ] but OASIS does not appear to be associated with IOL per se [ 52 ]. We used delivery blood loss ≥ 1000 ml as an adverse maternal outcome for the composite instead of the need for blood transfusion, which could be a more objective and clinically useful measure.…”

Section: Discussionmentioning

confidence: 99%

Short stature and vaginal dinoprostone as independent predictors of composite maternal-newborn adverse outcomes in induction of labor after one previous cesarean: a retrospective cohort study

Tan,

Bashirudin,

Rajaratnam

et al. 2024

BMC Pregnancy Childbirth

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Background The rates of labor induction and cesarean delivery is rising worldwide. With the confluence of these trends, the labor induction rate in trials of labor after cesarean can be as high as 27-32.7%. Induction of labor after one previous cesarean (IOLAC) is a high-risk procedure mainly due to the higher risk of uterine rupture. Nevertheless, the American College of Obstetricians and Gynecologists considers IOLAC as an option in motivated and informed women in the appropriate care setting. We sought to identify predictors of a composite of maternal and newborn adverse outcomes following IOLAC. Methods The electronic medical records of women who delivered between January 2018 to September 2022 in a Malaysian university hospital were screened to identify cases of IOLAC. A case is classified as a composite adverse outcome if at least one of these 11 adverse outcomes of delivery blood loss ≥ 1000 ml, uterine scar complications, cord prolapse or presentation, placenta abruption, maternal fever (≥ 38 0C), chorioamnionitis, intensive care unit (ICU) admission, Apgar score < 7 at 5 min, umbilical artery cord artery blood pH < 7.1 or base excess ≤-12 mmol/l, and neonatal ICU admission was present. An unplanned cesarean delivery was not considered an adverse outcome as the practical management alternative for a clinically indicated IOLAC was a planned cesarean. Bivariate analysis of participants’ characteristics was performed to identify predictors of their association with composite adverse outcome. Characteristics with crude p < 0.10 on bivariate analysis were incorporated into a multivariable binary logistic regression analysis model. Results Electronic medical records of 19,064 women were screened. 819 IOLAC cases and 98 cases with composite adverse outcomes were identified. Maternal height, ethnicity, previous vaginal delivery, indication of previous cesarean, indication for IOLAC, and method of IOLAC had p < 0.10 on bivariate analysis and were incorporated into a multivariable binary logistic regression analysis. After adjustment, only maternal height and IOLAC by vaginal dinoprostone compared to Foley balloon remained significant at p < 0.05. Post hoc adjusted analysis that included all unplanned cesarean as an added qualifier for composite adverse outcome showed higher body mass index, short stature (< 157 cm), not of Chinese ethnicity, no prior vaginal delivery, prior cesarean indicated by labor dystocia, and less favorable Bishop score (< 6) were independent predictors of the expanded composite adverse outcome. Conclusion Shorter women and IOLAC by vaginal dinoprostone compared to Foley balloon were independently predictive of composite of adverse outcome.

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Section: Discussionmentioning

confidence: 99%

Short stature and vaginal dinoprostone as independent predictors of composite maternal-newborn adverse outcomes in induction of labor after one previous cesarean: a retrospective cohort study

Tan,

Bashirudin,

Rajaratnam

et al. 2024

BMC Pregnancy Childbirth

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“…Previous studies show that overweight and obese women have a lower risk of OASI compared to women with normal weight [3][4][5] . However, a recently published study shows contrasting results, indicating that women with obesity are at higher risk of sustaining an OASI 24 . The contradicting results may depend on combinations of variables adjusted for.…”

Section: Maternal Overweight and Obesitymentioning

confidence: 93%

The impact of maternal body mass index on pelvic floor during labor and after childbirth, and a new anesthetic approach for repair of perineal lacerations

Hjertberg

2024

Linköping University Medical Dissertations

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ObjectivesThis thesis aimed to assess the impact of maternal body mass index (BMI) on pelvic floor during labor and focusing on pelvic floor function following an anal sphincter injury (OASI). Additionally, the objective was to design a study protocol for a randomized controlled trial (RCT) with the objective to evaluate the impact of supplementary anesthesia during the examination and repair of obstetric perineal lacerations. Material and MethodsStudy I was an observational prospective cohort study, conducted at the maternity ward Linköping University Hospital, including 207 primiparous women in the active phase of labor. Transperineal ultrasound was used for measurement of the anovaginal distance (AVD) during active phase of labor. AVD were analyzed in relation to the women´s BMI groups. Study II and III were nationwide Swedish register studies, including 6595 women with a first time vaginal birth complicated by an OASI. Data was sourced from the Swedish Perineal Laceration Register (PLR), based on medical records and patient reported outcome measurements (PROM). Women were categorized by BMI, and analyses were performed on PROM data at the 8 week follow-up (Study II), and at the 12 month follow-up (Study III), after an OASI. Study IV, is a study protocol for a RCT, with parallel groups. Women who undergo examination and repair of obstetric perineal lacerations (grade I and II) are randomized into two arms (1:1); analgesia with pudendal nerve block (PNB) with Ropivacaine®-the PNB group or analgesia with PNB in combination with patient-controlled sedation (PCS) with propofol, the PCS group. ResultsObese women exhibited a higher AVD compared to normal weight women. The mean AVD was 25 mm for primiparous women in the active phase of labor. Overweight and obese women reported fewer wound complications than normal weight women at 8 weeks postpartum. Additionally, overweight and obese women had a lower risk of anal incontinence (AI) at 8 weeks after an OASI compared to normal weight counterparts. However, at 12 months after an OASI, the risk of AI was comparable across BMI groups. Urinary incontinence (UI) was more prevalent among overweight and obese women, with a higher risk of UI both at 8 weeks and 12 months after an OASI compared to normal weight women. Overweight and obese women had a lower risk of reporting dyspareunia at 12 months after an OASI compared to normal weight women. Results from the ongoing RCT are pending. ConclusionsDifferences in the AVD during active phase of labor were observed between women with normal weight and those who were overweight or obese. The higher AVD in obese women compared to normal weight women may indicate a valuable anatomical distinction that could be protective for pelvic floor muscles vulnerable during labor. Furthermore, women sustaining an OASI after their first vaginal birth reported distinct complications at 8 weeks and 12 months postpartum based on BMI. Various explanations may underlie these differences in reported complications, including the hypothesis that women w...

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“…How ethnicity or race is defined varies between different studies. In our previous study 7 we found an increased risk of OASIS in those born outside of Europe which we wanted to explore further. Asian ethnicity has been associated with a significantly increased risk of OASIS, 8–10 and women from South Asia have been identified as being particularly high risk 11 .…”

Section: Introductionmentioning

confidence: 94%

Maternal origin matters: Country of birth as a risk factor for obstetric anal sphincter injuries

André,

Stuart,

Källén

2024

Intl J Gynecology & Obste

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ObjectiveObstetric anal sphincter injuries (OASIS) are severe complications to vaginal births with potential long‐term consequences. Maternal origin has been proposed to affect the overall risk, but the association and underlying explanation are uncertain. The objective was to assess the association between maternal country of birth and OASIS.MethodsA Swedish nationwide cohort study including singleton term vaginal births during 2005–2016. Data were extracted from the Swedish Medical Birth Registry and Statistics Sweden. Modified Poisson regression analyses were performed to obtain crude and adjusted risk ratios (RRs). Adjustments were made in four cumulative steps. Sub‐analyses were performed to investigate the risk of OASIS associated with female genital circumcision (FGC).ResultsIn all, 988 804 births were included. The rate of OASIS in Swedish‐born women was 3.5%. Women from East/Southeast Asia had an increased risk of OASIS (adjusted RR [aRR] 1.71, 95% confidence interval [CI] 1.60–1.83), as did women born in Sub‐Saharan Africa (aRR 1.60, 95% CI 1.49–1.72). The risk remained significantly increased also after adjustment for maternal height. By contrast, women from South/Central America had a decreased risk of OASIS (aRR 0.65, 95% CI 0.56–0.76). FGC was associated with an increased risk of OASIS (aRR 3.05, 95% CI 2.60–3.58). Episiotomy appeared to have an overall protective effect (aRR 0.95, 95% CI 0.92–0.98), but not significantly more protective among women with female genital mutilation.ConclusionsCountry of birth plays an important role in the risk of OASIS. Women from East/Southeast Asia and Sub‐Saharan Africa are at significantly increased risk as compared with Swedish‐born women, whereas women from South/Central America are at lower risk. FGC is also a significant risk factor for OASIS.

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Obstetric anal sphincter injuries—Maternal, fetal and sociodemographic risk factors: A retrospective register‐based study

Cited by 8 publications

References 31 publications

Short stature and vaginal dinoprostone as independent predictors of composite maternal-newborn adverse outcomes in induction of labor after one previous cesarean: a retrospective cohort study

Short stature and vaginal dinoprostone as independent predictors of composite maternal-newborn adverse outcomes in induction of labor after one previous cesarean: a retrospective cohort study

The impact of maternal body mass index on pelvic floor during labor and after childbirth, and a new anesthetic approach for repair of perineal lacerations

Maternal origin matters: Country of birth as a risk factor for obstetric anal sphincter injuries

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