Mode of delivery after previous obstetric anal sphincter injuries (OASIS)—a reappraisal?
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Introduction and hypothesis
To prospectively evaluate anorectal symptoms, quality of life (QoL), sphincter integrity and function after subsequent childbirth following previous obstetric anal sphincter injuries (OASIS).
A validated Manchester Health Questionnaire, endoanal sonography and manometry were performed during the third trimester and 13 weeks postpartum. Women without objective compromise of anal function were recommended a vaginal delivery and the others a caesarean section.
Seventy-three consecutive women with previous OASIS were seen during a subsequent pregnancy of whom 59 were reviewed 13 weeks following delivery. Anal manometry findings did not change significantly following a subsequent vaginal delivery or caesarean section. Only one new defect (internal sphincter) occurred after a vaginal delivery. There was no significant change in symptoms or QoL. Three (6.8%) sustained repeat OASIS.
Women who have no antenatal evidence of objective compromise of anal sphincter function can be reassured that a vaginal delivery is not associated with any significant deterioration in function or QoL.
KeywordsAnal sphincter repair Pregnancy Mode of delivery Third-degree tears Anal ultrasound Quality of life
I. Scheer was funded by a grant from the Mayday Childbirth Trust.
Conflicts of interest
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