Obstetric anal sphincter injury rates among primiparous women with different modes of vaginal delivery

Ampt, Amanda; Patterson, Jillian A.; Roberts, Christine L.; Ford, Jane B.

doi:10.1016/j.ijgo.2015.06.025

Cited by 35 publications

(21 citation statements)

References 18 publications

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“…The incidence of OASIS remained low during the study period, in contrast to some reports from Australia [ 24 ] and the UK [ 25 ]. The low incidence in Finland might be due to the practice of manually supporting the perineum when the baby’s head is crowning through the vaginal introitus [ 11 ].…”

Section: Discussioncontrasting

confidence: 67%

Outcomes of primary anal sphincter repair after obstetric injury and evaluation of a novel three-choice assessment

et al. 2018

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BackgroundThe aim of the present study was to evaluate the subjective outcome of primary repair of obstetric anal sphincter injury (OASIS) at 6 months, the factors associated with the symptoms of anal incontinence (AI), and the role of a simple survey consisting in one question with three answer choices, combined with the Wexner incontinence score for the assessment of this patient population.MethodsA retrospective cohort study was conducted on patients with third- or fourth-degree OASIS operated on between January 2007 and December 2013 inclusive at Tampere University Hospital, Finland. At 6 months, the patients were asked to report their Wexner’s score as well as the three-choice assessment regarding AI symptoms. Based on this assessment, the patients were divided into three groups: those, asymptomatic, those with mild symptoms who did not want further treatment and those with severe symptoms who were willing to undergo further evaluation and treatment.ResultsThere were 325 patients (median age 30 years). A total of 310 patients answered the questionnaire. Of which, one hundred and ninety-eight (63.9%) patients were asymptomatic, 85 (27.4%) had mild AI, and 27 (8.7%) experienced severe symptoms. There was no statistical difference in the results between the two techniques used (overlapping vs. end-to-end), or the stage of specialization of the operating physician. Persistent symptoms were associated with instrumental vaginal delivery (OR 2.12, 95% CI 1.32–3.41), severity of the injury (OR 1.64, 95% CI 1.20–2.25), and increased maternal age (OR 1.07, 95% CI 1.02–1.13). The correlation between the three-choice symptom evaluation and the Wexner score was good (Spearman’s rho 0.82).ConclusionsAfter 6 months, severe symptoms after OASIS repair were present in 9% of women and were more frequent in older women, women with high-degree tears and after instrumental vaginal delivery. A three-choice assessment of AI symptoms correlated well with the Wexner score and might be useful to triage patients who need further evaluation.

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Section: Discussioncontrasting

confidence: 67%

Outcomes of primary anal sphincter repair after obstetric injury and evaluation of a novel three-choice assessment

et al. 2018

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“…Changes in demographic risk factors such as the rise in maternal age, higher fetal birthweight, improvement of diagnostic attention, and better documentation through national birth registries explain only part of the substantial increase in obstetric anal sphincter injuries 8. Interestingly, in some countries, the use of forceps at delivery, although one of the major risk factors, has risen in the past years and may have contributed to this trend 8, 10…”

Section: Introductionmentioning

confidence: 99%

“…8 Interestingly, in some countries, the use of forceps at delivery, although one of the major risk factors, has risen in the past years and may have contributed to this trend. 8,10 Using the population-based database from the Austrian national birth registry, the aim of this study was to analyze risk and protective factors for obstetric anal sphincter injuries in first births in Austria and to describe time trends about the incidence of these injuries and associated risk factors in a country with a long-standing tradition of restricted use of forceps at delivery.…”

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confidence: 99%

Risk and protective factors for obstetric anal sphincter injuries: A retrospective nationwide study

Marschalek

Worda

Kuessel

et al. 2018

Birth

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BackgroundIn view of the reported increase in obstetric anal sphincter injuries, the objective of this study was to evaluate the incidence of such injuries over time and the associated risk and protective factors.MethodsThis was a retrospective cohort study from a national database of 168 137 primiparous women with term, singleton, cephalic, vaginal delivery between 2008 and 2014. The main outcome measure was obstetric anal sphincter injury. A multivariate regression model was used to identify risk and protective factors.ResultsAge >19 years, birthweight >4000 g, and operative vaginal delivery were independent risk factors for obstetric anal sphincter injuries. Mediolateral episiotomy increased the risk for obstetric anal sphincter injuries in spontaneous vaginal birth (number needed to harm 333), whereas it was protective in vacuum delivery (number needed to treat 50). From 2008 to 2014, there was an increase in the rate of obstetric anal sphincter injuries (2.1% vs 3.1%, P < .01), vacuum deliveries (12.1% vs 12.8%, P < .01), and cesarean delivery after labor (17.1% vs 19.4%, P < .01), while forceps deliveries (0.4% vs 0.1%, P < .01) and episiotomy rate decreased (35.9% vs 26.4%, P < .01).ConclusionsEpisiotomy may be a risk or protective factor depending on the type of episiotomy and the clinical setting in which it is used. Our study supports a restrictive use of mediolateral episiotomy in spontaneous vaginal deliveries. In vacuum deliveries mediolateral episiotomy may help prevent obstetric anal sphincter injuries.

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“…At 18 months follow‐up, 20 reported mild incontinence and four with moderate incontinence (Tjandra et al ). An observational study by Ampt et al (), indicated that the risk of sphincter injury rates have increased between the years 2001 to 2011 among both women that underwent delivery with the use of an episiotomy and without it. Yet the difference was found in whether the episiotomy was accompanied with any other instrumental aids.…”

Section: Anatomical Dissatisfactionmentioning

confidence: 99%

To cut or not to cut, that is the question: A review of the anatomy, the technique, risks, and benefits of an episiotomy

et al. 2017

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Childbirth can be a traumatic experience on the female body. Some techniques may be implemented to make the process smoother and decrease the potential lacerations that can occur. Episiotomies have been used by obstetricians and midwives to help make the fetal decent down the vaginal canal less turbulent. A physician must use his best judgment on when it is necessary to make this incision and what form of incision to make. Before making an incision one must understand the female external and internal anatomy and thoroughly comprehend the stages of birth to understand how and what complications can occur. Even though an episiotomy is a minor incision, it is still a surgical incision nonetheless and as with any form of surgery there are both risks and benefits that are to be considered. Nevertheless, episiotomies have proven to help ease births that are complicated by shoulder dystocia, prevent severe lacerations, and decrease the second stage of labor. The following comprehensive review provides a description of the female anatomy, as well as an extensive description of why, when, and how an episiotomy is done. Clin. Anat. 30:362-372, 2017. © 2017 Wiley Periodicals, Inc.

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Obstetric anal sphincter injury rates among primiparous women with different modes of vaginal delivery

Cited by 35 publications

References 18 publications

Outcomes of primary anal sphincter repair after obstetric injury and evaluation of a novel three-choice assessment

Outcomes of primary anal sphincter repair after obstetric injury and evaluation of a novel three-choice assessment

Risk and protective factors for obstetric anal sphincter injuries: A retrospective nationwide study

To cut or not to cut, that is the question: A review of the anatomy, the technique, risks, and benefits of an episiotomy

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