The consequences of undiagnosed obstetric anal sphincter injuries (OASIS) following vaginal delivery

Taithongchai, Annika; Veiga, Susana I.; Sultan, Abdul H.; Thakar, Ranee

doi:10.1007/s00192-019-04033-5

Cited by 37 publications

(23 citation statements)

References 28 publications

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“…Classification of perineal trauma ensures a thorough evaluation of anatomy and therefore an accurate repair of the trauma. OASI missed at delivery can effect a woman's physical and emotional recovery [22]. All guidelines, except the Dutch guideline [13], recommended classification with the widely accepted Sultan criteria [8].…”

Section: Classificationmentioning

confidence: 99%

Review of available national guidelines for obstetric anal sphincter injury

Roper

Amber²,

Wan

et al. 2020

Int Urogynecol J

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Introduction and hypothesis Obstetric anal sphincter injuries (OASIs) are the most severe form of perineal trauma with potentially devastating effects on a mother’s quality of life. There are various national guidelines available for their management. The aim of this study was to review and compare recommendations from published national guidelines regarding management and prevention of OASI. Methods We searched the PUBMED, EMBASE, MEDLINE, CINAHL and COCHRANE databases from January 2008 till October 2019 using relevant Medical Subject Headings (MeSH), including all subheadings. The guideline characteristics were mapped and methodological quality assessed with the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool by three independent reviewers. To compare the methodological quality of the guidelines, the interpretation of the six domain scores were taken into consideration. By consensus of the authors, a score of 70% was taken as a cut-off, and scores above this were considered ‘high quality’. Results Thirteen national guidelines on perineal trauma were included and analysed. Nine of these were specific to OASI. There is wide variation in methodological quality and evidence used for recommendations. AGREE scores for overall guideline assessment were > 70% in eight of the guidelines, with Australia-Queensland, Canada, the UK and USA scoring highest. Conclusions The wide variation in methodological quality and evidence used for recommendations suggests that there is a need for an agreed international guideline. This will enable healthcare practitioners to follow the same recommendations, with the most recent evidence, and provide evidence-based care to all women globally.

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Section: Classificationmentioning

confidence: 99%

Review of available national guidelines for obstetric anal sphincter injury

Roper

Amber²,

Wan

et al. 2020

Int Urogynecol J

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“…A significantly shorter mean size of the perineal body was found in women who sustained fourth-degree tears compared to those with third-degree tears (2.0 ± 0.7 vs. 2.5 ± 1.3, p < 0.01). This supports the importance of examining the perineal body during postpartum care, especially in cases of possible missed tears [18]. The reconstruction of the perineal body muscles is particularly important for supporting the sphincter repair as a short and deficient perineum can pose higher risks of OASI recurrence in future deliveries [3].…”

Section: Discussionmentioning

confidence: 70%

“…The one-stop model avoids multiple visits to the hospital, an important consideration in postpartum women. We found that combined AM and EAUS performed by the same physician at one visit optimizes the management plan by correlating with symptoms enabling a holistic approach to women with clinically recognized and unrecognized OASIs [18]. With improved clinical detection of OASIs in recent years due to improved training there is also a risk of overdiagnosis, reported in one large series to be 7% [30].…”

Section: Discussionmentioning

confidence: 83%

“…Women underwent vaginal examination to assess wound integrity, size of the perineal body (cm) and pelvic floor muscle contraction using the Modified Oxford Scale [24]. Appropriate investigations such as anal manometry (AM) and endoanal ultrasound scan (EAUS) were performed in all women with history of OASIs irrespective of symptoms or grade of OASI as previously reported [18,19] and when clinically indicated. Defects in the sphincter muscle were defined as ≥ 30°disruption (equivalent to > 1 h on the clock face) in the external anal sphincter (EAS) at the deep, superficial and/or subcutaneous levels or the internal anal sphincter (IAS) as previously described [22].…”

Section: Methodsmentioning

confidence: 99%

“…All women presenting with symptoms of AI and no history of OASI were offered AM and EAUS for assessment. EAS and IAS defects were found in 38 (36.8%) and 27 (19.5%) women, respectively; 40 (29.4%) women were diagnosed to have had clinically missed OASIs at the time of delivery and were managed as previously described [18]. Functional anal length, mean maximum resting pressure, mean maximum squeeze pressure and mean maximum cough reflex pressure were 1.7 ± 1.1 cm, 38.0 ± 24.4 mmHg, 77.0 ± 26.5 mmHg and 69.9 ± 23.1 mmHg, respectively.…”

Section: New Bowel Symptoms Without Oasismentioning

confidence: 98%

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A one-stop perineal clinic: our eleven-year experience

et al. 2020

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Introduction and hypothesis The perineal clinic is a dedicated setting offering assessment for various childbirth-related presentations including obstetric anal sphincter injuries (OASIs), perineal wound complications, pelvic floor dysfunction and other conditions such as female genital mutilation(FGM). We describe the clinical presentation and outcomes of women from a tertiary perineal clinic based on data collected over an 11-year period. Methods This is a retrospective observational study. A one-stop outpatient service was offered to all women who sustained OASIs (postnatally and antenatally in a subsequent pregnancy), perineal complications (within 16 weeks postpartum), FGM and/or peripartum symptoms of urinary/anal incontinence or prolapse. Assessment included history with validated questionnaires, examination and anal manometry and endoanal ultrasound when appropriate. Outcomes were compared among different grades of OASIs. Management of each type of presentation was reported with outcomes. Results There were 3254 first attendance episodes between 2006 and 2016. The majority (58.1%) were for OASIs, followed by perineal wound complications. Compared to the lower grades, the higher grades of OASI were associated with poorer outcomes in terms of symptoms, investigations and complications. Women with OASIs had unrelated symptoms such as urinary incontinence, perineal pain and wound infections that needed further intervention. A high proportion(42%) of wound complications required further specialist management. Conclusion We describe a dedicated, one-stop perineal clinic model for antenatal and postnatal women for management of perineal and pelvic floor disorders. This comprehensive and novel data will enable clinicians to better counsel women regarding of outcomes after OASI and focus training to minimize risks of morbidities.

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Follow up of women after obstetric anal sphincter injuries (OASI)—What is the role of anorectal testing?

Badri

Fowler

Lane

2023

Neurourology and Urodynamics

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Aims To evaluate the benefit of performing anorectal studies on all women following primary obstetric anal sphincter injury (OASI) repair over performing them on symptomatic women only. Methods Women who attended perineal clinic between 2007 and 2020 underwent symptom assessment and anorectal studies at 6 weeks and 6 months postpartum. Anorectal studies including endo anal ultrasound (EAUS) and anal manometry (AM) were performed. The anorectal studies of symptomatic women who were the case group, were compared with asymptomatic women who were the control group. Results A total of 1348 women were seen in the perineal clinic over 13 years. A total of 454 (33.7%) women were symptomatic. A total of 894 (66.3%) women were asymptomatic. A total of 313 (35%) asymptomatic women had two abnormal anorectal studies, 274 (31%) had abnormal AM alone, and 86 (9.6%) had abnormal EAUS alone. A total of 221 (24.7%) asymptomatic women had normal anorectal studies. Conclusion Almost 70% of women were asymptomatic 6 months following primary OASI repair. Most had at least one abnormal anorectal study result. Selectively performing anorectal tests on symptomatic women would not identify asymptomatic women at risk of future faecal incontinence following further vaginal birth. Without anorectal study results, women would not receive accurate counseling about the risks of vaginal birth. Anorectal studies should be offered to all women following OASI where resources allow.

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The consequences of undiagnosed obstetric anal sphincter injuries (OASIS) following vaginal delivery

Cited by 37 publications

References 28 publications

Review of available national guidelines for obstetric anal sphincter injury

Review of available national guidelines for obstetric anal sphincter injury

A one-stop perineal clinic: our eleven-year experience

Follow up of women after obstetric anal sphincter injuries (OASI)—What is the role of anorectal testing?

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