Risk factors for obstetric anal sphincter injuries (OASI) at a tertiary centre in south India

Gundabattula, Sirisha Rao; Surampudi, Kameswari

doi:10.1007/s00192-017-3398-0

Cited by 20 publications

(16 citation statements)

References 17 publications

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“…Our study found prime gravidas at an increased risk for OASIS. Indeed, parity is a well-known risk factor for thirdand fourth-degree perineal tears [19,[28][29][30]. e most biologically plausible mechanism is the limited elasticity of the perineum among nulliparous and prime gravida women compared to multigravidas [31].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda

Ali

Migisha

Ngonzi

et al. 2020

Obstetrics and Gynecology International

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Background. Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS. Objectives. To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH). Methods. We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants’ medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors. Results. The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2nd stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86–19.82, p=0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07–6.17, p=0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01–0.12, p<0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03–0.28, p<0.001). Conclusions and Recommendations. The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda

Ali

Migisha

Ngonzi

et al. 2020

Obstetrics and Gynecology International

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“…12 For the purpose of comparison, Marschalek et al, 2 in a national population-based study including only term single cephalic deliveries, reported a 2.6% incidence of OASIs. Similarly, a lower incidence, of 2.1%, was recently reported in an Indian tertiary healthcare center when the data was adjusted for birth weight > 500 g. 3 However, previous studies have reported higher rates of severe perineal tears in the group including term births only, ranging from 4.5 to 5.9%. 13,14 In the multivariate analysis, supine positions were associated with 53% of reduction in the rate of OASIs, whereas induced labor, analgesia, oxytocin use in the second stage of labor, and episiotomy did not have a significant effect.…”

Section: Discussionmentioning

confidence: 54%

“…The best maternal position adopted during the pelvic phase to avoid perineal damage is an issue that is still controversial, depending on a set of multifactorial predictors and specific subgroups of analysis. [1][2][3] High rates of obstetric anal sphincter injuries (OASIs) among women giving birth in the lithotomy position were reported in a population-based study 1 in Sweden on term non-instrumental births without episiotomy. However, another population-based research 2 in Austria, including primiparous term births, did not prove any effect of the birth positions on OASIs.…”

Section: Introductionmentioning

confidence: 99%

Do We Know How to Avoid OASIs in Non-Supine Birth Positions? A Retrospective Cohort Analysis

Reis

Pereira

Vianini

et al. 2019

Rev Bras Ginecol Obstet

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Objective To evaluate the association between the upright and supine maternal positions for birth and the incidence of obstetric anal sphincter injuries (OASIs). Methods Retrospective cohort study analyzed the data of 1,728 pregnant women who vaginally delivered live single cephalic newborns with a birth weight of 2,500 g. Multiple regression analyses were used to investigate the effect of the supine and upright positions on the incidence of OASIs after adjusting for risk factors and obstetric interventions. Results In total, 239 (13.8%) births occurred in upright positions, and 1,489 (86.2%) in supine positions. Grade-III lacerations occurred in 43 (2.5%) patients, and grade-IV lacerations occurred in 3 (0.2%) women. Supine positions had a significant protective effect against severe lacerations, odds ratio [95% confidence interval]: 0,47 [0.22–0.99], adjusted for the use of forceps 4.80 [2.15–10.70], nulliparity 2.86 [1.44–5.69], and birth weight 3.30 [1.56–7.00]. Anesthesia (p < 0.070), oxytocin augmentation (p < 0.228), shoulder dystocia (p < 0.670), and episiotomy (p < 0.559) were not associated with the incidence of severe lacerations. Conclusion Upright birth positions were not associated with a lower rate of perineal tears. The interpretation of the findings regarding these positions raised doubts about perineal protection that are still unanswered.

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“…Hehir et al [4] in a retrospective study found that episiotomy was a protective factor in cases of shoulder dystocia (p = 0.006). Likewise, Gundabattula and Surampudi [16] demonstrated an association between dystocia and OAST (OR = 7.81, 95% CI = 4.30 -14.18; p = 0.000).…”

Section: Discussionmentioning

confidence: 87%

“…Conversely, some studies have observed mediolateral episiotomy as a protective factor for OAST. Zafran and Salim [15], in a retrospective study comparing selective and routine use of episiotomy, found that the incidence of OAST was significantly higher with selective use (OR = 2.23, 95% CI = 1.16 -4.29, p = 0.02) Gundabattula and Surampudi [16], in a retrospective study, evaluated the occurrence of OAST and identified episiotomy as a protective factor (OR = 0.57, 95% CI = 0.40 -0.83, p = 0.003) and Verghese et al [17], in a systematic review comparing OAST rates, found that episiotomy was a protective factor (RR = 0.67, 95% CI = 0.49 -0.92). In this review, all the studies evaluated were non-randomized, population-based or retrospective.…”

Section: Discussionmentioning

confidence: 99%

Impact of Selective vs Routine Midline Episiotomy and Lacerations of the Anal Sphincter

Schneider¹,

Perez²,

Silva³

et al. 2019

OJOG

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Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery; however, several studies have shown that routine use of episiotomy does not reduce the risk of OAST. Objective: This study aims to analyse whether the reduction in the rate of episiotomy in a school hospital in Brazil was associated with an increase in the incidence of obstetric lacerations of the anal sphincter, in addition to associated factors. Methods: Observational, cross-sectional and retrospective study. We included all vaginal deliveries of single pregnancies, cephalic presentation, from 34 weeks of gestational age, performed in 2011-2012 (liberal episiotomy) and 2015-2016 (restricted episiotomy), and compared in relation to the rate of mediolateral episiotomy and OAST. Results: 4268 births were analysed (2043 in 2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to 44.2% (p ≤ 0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations in 2225 births (1.39%). There was interaction when comparing the two periods in relation to the episiotomy and the occurrence of OAST (p ≤ 0.0001). Factors associated with OAST were labor induction and shoulder dystocia. Conclusion: There was an increase in the rate of lacerations of the anal sphincter with use of restrictive episiotomy. However, this increase occurred both in deliveries with and in deliveries without episiotomy.

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Risk factors for obstetric anal sphincter injuries (OASI) at a tertiary centre in south India

Abstract: Risk factors are similar to those in other population groups; however, primiparity appears to be associated with lesser risk and forceps delivery with greater risk of sphincter trauma than previously reported.

Cited by 20 publications

References 17 publications

Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda

Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda

Do We Know How to Avoid OASIs in Non-Supine Birth Positions? A Retrospective Cohort Analysis

Impact of Selective vs Routine Midline Episiotomy and Lacerations of the Anal Sphincter

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