The incidence of and risk factors for a repeat obstetric anal sphincter injury (OASIS) in the vaginal birth subsequent to a first episode of OASIS: a hospital-based cohort study

Antonakou, Angeliki; Papoutsis, Dimitrios; Henderson, K.; Qadri, Zahid; Tapp, A.

doi:10.1007/s00404-017-4352-6

Cited by 12 publications

(36 citation statements)

References 24 publications

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“…The following vaginal delivery rate of 67% (versus approximately 95% for multiparous women in general) [16] is not unexpected given the ongoing morbidity experienced. An 8.8% rate of repeat OASI is in keeping with the literature, with Antonakou et al [17] reporting rates of 8.4%. These rates should be disclosed when counseling women on subsequent birth choices, the reality being that for one in ten of the women surveyed, they decided to have no further children because of their OASI.…”

Section: Discussionsupporting

confidence: 84%

What is the total impact of an obstetric anal sphincter injury? An Australian retrospective study

et al. 2019

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Introduction Most data on obstetric anal sphincter injury (OASI) reflect short-term (< 12 months) or much longer term (> 10 years) impact. This study aimed to collate the extent of medium-term symptomology (1-6 years) and observe the effect on future birth choices to evaluate the cumulative impact of OASI in affected women. Methods A retrospective cohort of women affected by OASI completed a questionnaire covering bowel symptomology, sexual function, life impact and future birth choices. A custom-created adverse composite outcome for OASI incorporating effects on daily life, flatal/fecal incontinence and sexual function (OASIACO) was used as a threshold score to identify women with high levels of symptoms. Results Of 265 eligible and contactable women, 210 questionnaires were received (response rate 79%) at a mean of 4 years post-OASI. More than half (54%) experienced an OASIACO. A forceps birth (p = 0.03) or more severe grade of tear (p = 0.03) was predictive of OASIACO. One hundred one women had further children, with 48% reporting their delivery choices were impacted, 32% electing a cesarean delivery and 26% shifting to private care. Eighty women (40%) had not given birth again, and 29 (36%) of these indicated their OASI influenced this decision. Conclusions The total impact of an OASI on women affected is substantial. More than half experience ongoing symptoms and close to half report an impact on their future birth choices. It follows there would be a consequential load on the healthcare sector, and improved management and prevention programs should be implemented.

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Section: Discussionsupporting

confidence: 84%

What is the total impact of an obstetric anal sphincter injury? An Australian retrospective study

et al. 2019

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“…While the impact of episiotomy on the index delivery was investigated [2, 8], to the best of our knowledge, our study is the largest to investigate whether episiotomy in the index delivery influence the delivery and labor outcomes on subsequent delivery. Antonakou et al found that women who had an episiotomy at first vaginal birth had an almost fourfold increased risk of repeat obstetric anal sphincter injury in a second vaginal birth [13]. …”

Section: Discussionmentioning

confidence: 99%

Once episiotomy, always episiotomy?

Zilberman

Barrett

Hamou

et al. 2018

Arch Gynecol Obstet

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ObjectiveTo investigate the association between episiotomy and perineal damage in the subsequent delivery.Study designA retrospective cohort study was conducted, comparing outcome of subsequent singleton deliveries of women with and without episiotomy in their first (index) delivery. Deliveries occurred between the years 1991–2015 in a tertiary medical center. Traumatic vaginal tears, multiple pregnancies, and cesarean deliveries (CD) in the index pregnancy were excluded from the analysis. Multiple logistic regression models were used to control for confounders.ResultsDuring the study period, 43,066 women met the inclusion criteria; of them, 50.4% (n = 21,711) had subsequent delivery after episiotomy and 49.6% (n = 21,355) had subsequent delivery without episiotomy in the index pregnancy. Patients with episiotomy in the index birth higher rates of subsequent episiotomy (17.5 vs. 3.1%; P < 0.001; OR 1.9; 95% CI). In addition, the rates of the first and second degree perineal tears as well as the third and fourth degree perineal tears were significantly higher in patients following episiotomy (33.6 vs. 17.8%; P < 0.001, and 0.2 vs. 0.1%; P = 0.002, respectively). Nevertheless, there was no significant difference at the rates of CD and instrumental deliveries, between the groups. While adjusting for maternal age, ethnicity, birth weight, and vacuum delivery—the previous episiotomy was noted as an independent risk factor for recurrent episiotomy in the subsequent delivery (adjusted OR 6.7; 95% CI 6.2–7.3, P < 0.001). The results remained significant for term (adjusted OR 6.8; 95% CI 6.2–7.4, P < 0.001) as well as preterm deliveries (adjusted OR 4.5; 95% CI 3.3–6.3, P < 0.001) in two different models.ConclusionEpisiotomy is an independent risk factor for recurrent episiotomy in the subsequent delivery.

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“…Women with a previous OASIS were excluded from this study as the literature reports a fivefold increased risk of recurrence of severe perineal trauma in these cases. [19][20][21] This means that any OASIS would most likely be due to the prior OASIS and not by any exposures during birth.…”

Section: Methodsmentioning

confidence: 99%

The Incidence of and Predictors for Severe Perineal Trauma and Intact Perineum in Women Having a Waterbirth in England: A Hospital-Based Study

Papoutsis

Antonakou

Gornall

et al. 2021

Journal of Women's Health

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Background: To determine the incidence of and predictors for obstetric anal sphincter injuries (OASIS) and intact perineum in women giving birth in the water and compare with the general obstetric population. Materials and Methods: Data were retrospectively collected for women who had singleton cephalic presentation vaginal births in the water and the general obstetric population between August 2007 and December 2017. Results: We identified 1,007 women who had a waterbirth and 36,924 women from the general obstetric population. There was no significant difference in the incidence of OASIS between waterbirths and the general obstetric population (2.3% vs. 2.0%). Having a waterbirth was associated with a lower probability for an intact perineum (odds ratio [OR] = 0.83; confidence interval [95% CI]: 0.73-0.94) when compared with the general obstetric population (44.7% vs. 51.3%). Nulliparous women with a waterbirth when compared with multiparous women had an eightfold higher likelihood for the occurrence of OASIS (OR = 8.28; 95% CI: 2.64-25.86). The risk for a higher degree of OASIS was associated with increased maternal age in the total sample (OR = 1.08; 95% CI: 1.06-1.11) and with a lower body mass index (BMI) at booking in multiparous women (OR = 0.96; 95% CI: 0.92-0.99). The risk for any type of perineal trauma was associated with increased maternal age in the total sample (OR = 1.10; 95% CI: 1.07-1.13) and with a lower BMI at booking in multiparous women (OR = 0.95; 95% CI: 0.91-0.99). Conclusions: We found that giving birth in the water reduced the chance of having an intact perineum. We have also shown that nulliparity, increased maternal age in all women, and a lower BMI at booking in multiparous were associated with OASIS and lower rates of intact perineum in waterbirths.

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The incidence of and risk factors for a repeat obstetric anal sphincter injury (OASIS) in the vaginal birth subsequent to a first episode of OASIS: a hospital-based cohort study

Abstract: We found that 8.4% of women sustained a repeat OASIS in a subsequent vaginal birth with this risk being associated with the presence of a short second labour and certain features from the first labour.

Cited by 12 publications

References 24 publications

What is the total impact of an obstetric anal sphincter injury? An Australian retrospective study

What is the total impact of an obstetric anal sphincter injury? An Australian retrospective study

Once episiotomy, always episiotomy?

The Incidence of and Predictors for Severe Perineal Trauma and Intact Perineum in Women Having a Waterbirth in England: A Hospital-Based Study

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