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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

  • General Gynecology
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To identify the incidence of and risk factors for a repeat obstetric anal sphincter injury (OASIS) in women who sustained an OASIS in their first vaginal delivery and have a subsequent vaginal birth.

Methods

Data were collected retrospectively for women having had singleton cephalic presentation vaginal deliveries between 2007 and 2015. Women with breech deliveries, stillbirths, foetal congenital abnormalities and multiple pregnancies were excluded.

Results

Over the study period, we identified 11,191 women who had a first vaginal birth, of which 603 (5.4%) sustained a first episode of OASIS. Of these women, 243 (40.2%) had a subsequent pregnancy with 190 (78.1%) having a second vaginal birth, 13 (5.4%) an emergency caesarean section (CS) delivery while in labour and 40 (16.5%) an elective CS delivery. In those who delivered vaginally, 16 (8.4%) women had a repeat OASIS. After adjusting for several confounding factors, it was found that the risk of a repeat OASIS was associated with the use of epidural analgesia (OR = 3.66; 95% CI: 1.14–11.71) and an episiotomy in the first delivery (OR = 3.93; 95% CI:1. 03–15.02) and a short labour (<2.8 h) in the second delivery (OR = 14.55; 95% CI: 1.83–115.75). The time interval between the two vaginal births was not associated with any increased risk of a repeat OASIS.

Conclusion

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.

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Acknowledgements

We would like to thank Christopher Weston, data analyst of Medway electronic database at the Shrewsbury and Telford Hospital NHS Trust for his contribution and support in the data collection for this study.

Author contributions

AA: Protocol/project development, Data collection and data management, Data analysis, Manuscript writing and editing. DP: Protocol/project development, Data management, Data analysis, Manuscript writing and editing. KH, ZQ: Manuscript writing and editing. AT: Protocol/project development, Data analysis, Manuscript writing and editing.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Princess Royal Hospital, Apley Castle, Grainger Drive, Telford, TF16TF, UK

    Angeliki Antonakou, Dimitrios Papoutsis, Karen Henderson, Zahid Qadri & Andrew Tapp

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  1. Angeliki Antonakou
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  2. Dimitrios Papoutsis
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  3. Karen Henderson
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  4. Zahid Qadri
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Corresponding author

Correspondence to Angeliki Antonakou.

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Funding

None. At the time of this study, Dr Angeliki Antonakou was a Postdoctoral Clinical Research Fellow in the field of perineal trauma, at the Shrewsbury and Telford Hospital, NHS Trust.

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Our study involved retrospective collection of data, and for this type of study formal consent is not required.

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Antonakou, A., Papoutsis, D., Henderson, K. et al. 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. Arch Gynecol Obstet 295, 1201–1209 (2017). https://doi.org/10.1007/s00404-017-4352-6

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  • DOI: https://doi.org/10.1007/s00404-017-4352-6

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