Mode of delivery and perineal injury following primary obstetric anal sphincter injury
Citation: BJOG: An International Journal of Obstetrics and Gynaecology, April 2014, vol./is.
121/(228), 1470-0328 (April 2014)
Author(s): Nausheen S.; Roberts A.J.; Wakefield N.; Canavan L.; Dinardo L.
Abstract: Introduction Obstetric anal sphincter injury (OASI) complicates 1% of vaginal deliveries. It is believed that 60-80% of women are asymptomatic following OASI repair at 12 months but studies have shown that 17-24% developed worsening of faecal symptoms after a second vaginal delivery. The risk of recurrent OASI is believed to be 5-7 fold higher in women with a previous OASI, however the true recurrence is not exactly known due to various confounding factors. Methods We conducted a retrospective review of deliveries in two maternity units in the Mersey Deanery (UK), between 2007 and 2012 (29 706 deliveries). We identified 176 women who had sustained an OASI in a previous pregnancy who went on to have a subsequent delivery, (188 subsequent deliveries).The primary outcomes studied were mode of delivery and perineal injury sustained in the subsequent delivery.
Data collection also included faecal symptoms, rates of postnatal follow-up after the primary OASI, and attendance and counselling in antenatal clinic in Evidence Services | library.nhs.uk
Page 4 the subsequent pregnancy. Results Regarding mode of delivery in the subsequent pregnancies there were 141/188 (75.0%) spontaneous vaginal deliveries, 4/188 (2.1%) instrumental deliveries, 25/188 (13.3%) caesarean sections for previous OASI, and 18/188 (9.6%) caesarean sections for other indications. Of the 145 vaginal deliveries, the recurrence rate of OASI was 3/145 (2.1%). A second degree tear was sustained in 97/145 (66.9%), first degree in 15/145 (10.3%), episiotomy in 17/145 (11.7%), and the perineum
was intact in 13/145 (9.0%).After the primary OASI, 22/176 women (12.5%) had faecal symptoms, 59.1% of these were transient and 40.9% were persistent. There was no documentation of postnatal follow-up after the primary OASI in 20.8% patients. Furthermore, 12.8%were not documented to have been seen by an obstetrician in high risk antenatal clinic in the subsequent pregnancy. There was no documentation of counselling regarding the previous OASI in 36.8% and where counselling was documented, it most often included only mode of delivery.
Conclusion In our series, 77.1% women achieved a vaginal birth following a previous OASI and only 2.1% of these sustained a recurrence, which is fairly low compared to the rates quoted in literature of 7.1%. Antenatal counselling is poorly documented and this needs to be improved. We
also recommend the use of this data in information leaflets to allow women to make an informed choice regarding the mode of delivery following OASI. We need to use validated symptom questionnaires during follow-up to evaluate the functional outcomes.
Publication Type: Journal: Conference Abstract
Full Text: Available from Wiley in BJOG: An International Journal of Obstetrics and Gynaecology