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The use of metronidazole in women undergoing obstetric anal sphincter injuries: a systematic review of the literature

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Abstract

Purpose

Antibiotic treatment during surgical repair of obstetric anal sphincter injuries (OASIS) had been a matter of debate. We aimed to review the available literature regarding the efficacy of metronidazole administration in women undergoing perineal repair following obstetric OASIS.

Study design

To identify potentially eligible studies, we searched PubMed, Scopus, Embase and the Cochrane Library from inception to January 13th, 2019.Reference lists of identified studies were searched. No language restrictions were applied. We used a combination of keywords and text words represented by “Metronidazole”, “obstetrics”, “obstetric anal sphincter injury”, “OASIS”, “third degree tear”, “fourth degree tear”, “third degree laceration”, “fourth degree laceration”, “antibiotic therapy”, “perineal damage” and “perineal trauma”.

Two reviewers independently screened the titles and abstracts of records retrieved from the database searches. Both reviewers recommended studies for the full-text review. Thescreen of full-text articles recommended by at least one reviewer was done independently by the same two reviewers and assessedfor inclusion in the systematic review. Disagreements between reviewers were resolved by consensus.

Results

The electronic database search yielded a total of 54,356 results (Fig. 1). After duplicate exclusion 28,154 references remained. Of them, 26 were relevant to the review based on title and abstract screening. None of these articles dealt with the use of metronidazole for the prevention of infections complicating anal sphincter repair in women with OASIS. A Cochrane review addressing antibiotic prophylaxis for patients following OASIS, compared prophylactic antibiotics against placebo or no antibiotics, included only one randomized controlled trial of 147 participants. This study showed that prophylactic antibiotics (not metronidazole) may be helpful to prevent perineal wound complications following OASIS.

Study seection process

Conclusion

Anaerobic infections potentially complicate wound repair after OASIS. Although scientific societies recommend the use of antibiotics for the prevention of infectious morbidity after OASIS, no study has specifically assessed the role of metronidazole.

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References

  1. Ginath S, Mizrachi Y, Bar J, Condrea A, Kovo M (2017) Obstetric Anal Sphincter Injuries (OASIs) in Israel: a review of the incidence and risk factors. Rambam Maimonides Med J 8(2):18. https://doi.org/10.5041/RMMJ.10295

    Article  Google Scholar 

  2. Lau J, Antman EM, Jimenez-Silva J, Kuplenick B, Mosteller F (2011) For personal use only No other uses without permission. Massachusetts Med Soc 2(12):3

    Google Scholar 

  3. Guzmán Rojas RA, Shek KL, Langer SM, Dietz HP (2013) Prevalence of anal sphincter injury in primiparous women. Ultrasound Obstet Gynecol 42(4):461–466. https://doi.org/10.1002/uog.12481

    Article  PubMed  Google Scholar 

  4. Andrews V, Sultan AH, Thakar R, Jones PW (2006) Occult anal sphincter injuries - Myth or reality? BJOG An Int J Obstet Gynaecol 113(2):195–200. https://doi.org/10.1111/j.1471-0528.2006.00799.x

    Article  Google Scholar 

  5. Andrews V, Thakar R, Sultan AH (2009) Structured hands-on training in repair of obstetric anal sphincter injuries (OASIS): an audit of clinical practice. Int Urogynecol J 20(2):193–199. https://doi.org/10.1007/s00192-008-0756-y

    Article  Google Scholar 

  6. Factors R (2008) Obstetric anal sphincter injury. Ann surgery 247(2):224–237. https://doi.org/10.1097/SLA.0b013e318142cdf4

    Article  Google Scholar 

  7. Ramm O, Woo VG, Hung Y, Weintraub MLR (2018) Risk factors for the development of obstetric anal sphincter injuries in modern obstetric practice. Obstetric 131(2):290–296. https://doi.org/10.1097/AOG.0000000000002444

    Article  Google Scholar 

  8. De LJW, Struijk PC, Vierhout ME, Wallenburg HCS (2001) Risk factors for third degree perineal ruptures during delivery. Inter J Obstet Gynaecol 108:383–387

    Article  Google Scholar 

  9. Hehir MP, Rubeo Z, Flood K et al (2018) Anal sphincter injury in vaginal deliveries complicated by shoulder dystocia. Inter urogynecol J 1:377–381. https://doi.org/10.1007/s00192-017-3351-2

    Article  Google Scholar 

  10. Jha S, Parker V (2016) Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis. Int Urogynecol J 27(6):849–857. https://doi.org/10.1007/s00192-015-2893-4

    Article  PubMed  Google Scholar 

  11. Sheiner E, Levy A, Walfisch A, Hallak M, Mazor M (2005) Third degree perineal tears in a university medical center where midline episiotomies are not performed. Arch Gynecol Obstet 271(4):307–310. https://doi.org/10.1007/s00404-004-0610-5

    Article  PubMed  Google Scholar 

  12. Steiner N, Weintraub AY, Wiznitzer A, Sergienko R, Sheiner E (2012) Episiotomy: the final cut? Arch Gynecol Obstet 286(6):1369–1373. https://doi.org/10.1007/s00404-012-2460-x

    Article  PubMed  Google Scholar 

  13. Fornell EU, Matthiesen L, Sjo R (2005) Obstetric anal sphincter injury ten years after: subjective and objective long term effects. Inter urogynecol J 112:312–316

    Google Scholar 

  14. Pollack J, Nordenstam J, Brismar S, Lopez A (2004) Anal incontinence after vaginal delivery : a five-year prospective cohort study. Obstet Gynecol 104(6):1397–1402. https://doi.org/10.1097/01.AOG.0000147597.45349.e8

    Article  PubMed  Google Scholar 

  15. Hehir MP, Connor HDO, Higgins S et al (2013) Obstetric anal sphincter injury, risk factors and method of delivery – an 8-year analysis across two tertiary referral centers. J Mater Fetal Neonatal Med 7058:8–11. https://doi.org/10.3109/14767058.2013.791268

    Article  Google Scholar 

  16. Webb SS, Yates D, Manresa M et al (2017) Impact of subsequent birth and delivery mode for women with previous OASIS : systematic review and meta-analysis. OASIS 2:507–514. https://doi.org/10.1007/s00192-016-3226-y

    Article  Google Scholar 

  17. Stock L, Basham E, Gossett DR, Lewicky-Gaupp C (2013) Factors associated with wound complications in women with obstetric anal sphincter injuries. Am J Obstet Gynecol 8(4):327–327. https://doi.org/10.1016/j.ajog.2012.12.025

    Article  Google Scholar 

  18. Zarutskij VA, Prokopenko NY (2002) Oscillations and stability of shallow ribbed shells rectangular in plane. Prikl Mekhanika 38(6):84–90. https://doi.org/10.1097/AOG.0000000000000833

    Article  Google Scholar 

  19. Buppasiri P, Lumbiganon P, Thinkhamrop J, Thinkhamrop B (2014) Antibiotic prophylaxis for third- and fourth-degree perineal tear during vaginal birth. Cochrane Database Syst Rev 20:14–101. https://doi.org/10.1002/14651858.CD005125.pub4

    Article  Google Scholar 

  20. Update I (2018) Clinical management guidelines for obstetrician – gynecologists prevention and management of obstetric lacerations at vaginal delivery. Compa Issues 132(165):87–102

    Google Scholar 

  21. Trial ARC (2008) Antibiotic prophylaxis for prevention of postpartum perineal wound complications. Obstet Gynecol 111(6):1268–1273

    Article  Google Scholar 

  22. Meister MR, Fellow C, Surgery R et al (2019) HHS public access. Public Health 73(1):33–39. https://doi.org/10.1097/OGX.0000000000000521.Techniques

    Article  Google Scholar 

  23. Lo S, Edlund C, Nord CE (2010) Metronidazole is still the drug of choice for treatment of anaerobic infections. Metronidazole Drug 50(5):1. https://doi.org/10.1086/647939

    Article  CAS  Google Scholar 

  24. Elliott TSSJ (1990) Review article: metronidazole and the anaerobic gut flora. Aliment Pharmacol Ther 4(3):227–238

    Article  CAS  Google Scholar 

  25. Stock L, Basham E, Gossett DR, Lewicky-gaupp C (2013) Factors associated with wound complications in women with obstetric anal sphincter injuries (OASIS ). YMOB 208(4):e1–e6. https://doi.org/10.1016/j.ajog.2012.12.025

    Article  Google Scholar 

  26. Kammerer-doak DN, Wesol AB, Rogers RG, Celia E, Dorin MHA (2014) Prospective cohort study of women after primary repair of obstetric anal sphincter laceration. Public health 1:1317–1323

    Google Scholar 

  27. Williams MK, Chames MC (2006) Risk factors for the breakdown of perineal laceration repair after vaginal delivery. J Mater Fetal Neonatal Med 3:9–12. https://doi.org/10.1016/j.ajog.2006.06.085

    Article  Google Scholar 

  28. Lewicky-Gaupp C, Leader-Cramer A, Johnson LL, Kimberly Kenton DRG (2015) Wound complications after obstetric anal sphincter injuries. Obs Gynecol 125(5):1088–1093

    Article  Google Scholar 

  29. No GG (2015) The management of third- and fourth-degree perineal tears. MIDIRS 2:9

    Google Scholar 

  30. Article CMER (2018) CME review article 73(12):695–702

    Google Scholar 

  31. Opinion C (2013) Guidelines for the management of third and fourth degree perineal tears after vaginal birth from the Austrian Urogynecology Working Group. Urogynecology 1:553–558. https://doi.org/10.1007/s00192-012-1982-x

    Article  Google Scholar 

  32. Australian S, Practice P (2006) Third and fourth degree tear management. British J Midwifery 1:10

    Google Scholar 

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Funding

This study was not funded.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School, 12 Bayit Street, 91031, Jerusalem, Israel

    Reut Rotem & Misgav Rottenstreich

  2. Department of Obstetrics and Gynecology, Ospedaledei Bambini “Vittore Buzzi”, University of Milan, Milan, Italy

    Salvatore Andrea Mastrolia

  3. Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel

    David Yohay & Adi Y. Weintraub

Authors
  1. Reut Rotem
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  2. Salvatore Andrea Mastrolia
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  3. Misgav Rottenstreich
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  4. David Yohay
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  5. Adi Y. Weintraub
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Contributions

RR: protocol development, data collection and management, data analysis, manuscript writing/editing. SAM: protocol development, manuscript writing/editing. MR: protocol development, manuscript writing/editing. DY: protocol development, manuscript writing/editing. AYW: protocol development, data collection and management, data analysis, manuscript writing/editing.

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Correspondence to Misgav Rottenstreich.

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Rotem, R., Mastrolia, S.A., Rottenstreich, M. et al. The use of metronidazole in women undergoing obstetric anal sphincter injuries: a systematic review of the literature. Arch Gynecol Obstet 302, 321–328 (2020). https://doi.org/10.1007/s00404-020-05651-x

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  • DOI: https://doi.org/10.1007/s00404-020-05651-x

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