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Mode of delivery following obstetric anal sphincter injury: a 7-year retrospective review and follow-up cohort survey

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A Commentary to this article was published on 23 July 2022

Abstract

Introduction and hypothesis

Limited evidence exists regarding long-term outcomes following birth after prior obstetric anal sphincter injury (OASI). This article set out to describe outcomes following birth after OASI by reviewing the grades of tear, endoanal ultrasound (EAUS) findings, subsequent delivery outcomes and long-term symptoms.

Methods

This study was conducted in two parts. The first involved a retrospective review of all OASI at a tertiary hospital in Australia over 7 years (2013–2019 inclusive) where the patient underwent a subsequent delivery. Following this, a retrospective cohort survey of this group was performed.

Results

There were 27,284 vaginal births and 828 OASIs (3.03%); 247 (29.8%) had at least one subsequent birth by January 2021. Vaginal delivery occurred in 68%; recurrence of OASI was 5.4%. There were 90 responses (36.4%) to the follow-up survey. EAUS had been performed in 87.5%; none demonstrated a defect. Vaginal birth was the preferred mode for 77.8%; this occurred in 64%. The majority had high levels of satisfaction, this related to communication rather than the mode of delivery itself. Ongoing faecal or flatal incontinence was reported by 12%. There was no statistically significant difference in St Mark’s incontinence scores between modes of birth.

Conclusions

In our unit most women who sustain OASI will have a subsequent vaginal delivery in future pregnancies. The majority remain asymptomatic at long-term follow-up with no statistically significant difference in incontinence scores regardless of mode of delivery. The rate of recurrent OASI was 5.4%.

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References

  1. Australian Institute of Health and Welfare. National Core Maternity Indicators. Canberra: AIHW; 2018.

    Google Scholar 

  2. Evans E, Falivene C, Briffa K, Thompson J, Henry A. What is the total impact of an obstetric anal sphincter injury? An Australian retrospective study. Int Urogynecol J. 2020;31(3):557–66. https://doi.org/10.1007/s00192-019-04108-3.

    Article  PubMed  Google Scholar 

  3. RCOG. Third- and Fourth-degree Perineal Tears, Management (Green-top Guideline 29). RCOG Greentop Guidelines. London: RCOG; 2015.

    Google Scholar 

  4. Webb SS, Sitch A, MacArthur C. The impact of mode of subsequent birth after obstetric anal sphincter injury on bowel function and related quality of life: a cohort study. Int Urogynecol J. 2020;31(11):2237–45. https://doi.org/10.1007/s00192-020-04234-3.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Abramowitz L, Mandelbrot L, Bourgeois Moine A, Tohic A, Carne Carnavalet C, Poujade O, et al. Caesarean section in the second delivery to prevent anal incontinence after asymptomatic obstetric anal sphincter injury: the EPIC multicentre randomised trial. BJOG: Int J Obstet Gy. 2021;128(4):685–93. https://doi.org/10.1111/1471-0528.16452.

    Article  CAS  Google Scholar 

  6. Jangö H, Langhoff-Roos J, Rosthøj S, Sakse A. Mode of delivery after obstetric anal sphincter injury and the risk of long-term anal incontinence. Am J Obstet Gynecol. 2016;214(6):733.e1–733.e13. https://doi.org/10.1016/j.ajog.2015.12.030.

    Article  Google Scholar 

  7. Luxford E, Bates L, King J. 'Please squeeze': A novel approach to perineal guarding at the time of delivery reduced rates of obstetric anal sphincter injury in an Australian tertiary hospital. Aust N Z J Obstet Gynaecol. 2020;60(6):914–8. https://doi.org/10.1111/ajo.13181.

    Article  PubMed  Google Scholar 

  8. Jordan PA, Naidu M, Thakar R, Sultan AH. Effect of subsequent vaginal delivery on bowel symptoms and anorectal function in women who sustained a previous obstetric anal sphincter injury. Int Urogynecol J. 2018;29(11):1579–88. https://doi.org/10.1007/s00192-018-3601-y.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Edwards M, Kobernik EK, Suresh S, Swenson CW. Do women with prior obstetrical anal sphincter injury regret having a subsequent vaginal delivery? BMC Pregnancy Childbirth. 2019;19(1):225. https://doi.org/10.1186/s12884-019-2380-x.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ampt AJ, Roberts CL, Morris JM, et al. The impact of first birth obstetric anal sphincter injury on the subsequent birth: a population-based linkage study. BMC Pregnancy Childbirth. 2015;15:31. https://doi.org/10.1186/s12884-015-0469-4.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Urogynaecology, Westmead Hospital, Sydney, NSW, 2145, Australia

    R. Young, L. Bates, S. The & J. King

  2. Department of Urogynaecology, St George Hospital, Belgrave St, Kogarah, Sydney, NSW, 2217, Australia

    R. Young

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  1. R. Young
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  2. L. Bates
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  3. S. The
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  4. J. King
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Contributions

• Rebecca Young: Project development, data collection, data analysis, manuscript writing and editing

• Lucy Bates: Project development, data collection, manuscript editing

• Stephanie The: Data collection, manuscript editing

• Jennifer King: Project development, manuscript editing

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Correspondence to R. Young.

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Conflict of interest

Lucy Bates is a board member for the Urogynaecological Society of Australasia. Jennifer King is a board member of the Continence Foundation of Australia.

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Young, R., Bates, L., The, S. et al. Mode of delivery following obstetric anal sphincter injury: a 7-year retrospective review and follow-up cohort survey. Int Urogynecol J 33, 3365–3369 (2022). https://doi.org/10.1007/s00192-022-05294-3

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  • DOI: https://doi.org/10.1007/s00192-022-05294-3

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