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Berlin survey on obstetric anal sphincter injury (OASI)

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

Abstract

Purpose

Obstetric anal sphincter injuries (OASIs) complicate about 5% of vaginal births. The risk of anal incontinence is increased. OASI detection rates improve with knowledge and experience. This study describes Berlin’s medical care 10 years after starting training focusing on standards set at the German speaking country guideline on third degree tears.

Methods

In 2018, women experiencing OASIs in Berlin’s obstetric departments were informed about the study, including standardized after-care. Descriptive analysis in respect to anal sphincter function and risk factor analysis was performed.

Results

207 OASIs occurred in Berlin. 189 women participated. In 148 cases guideline according terminology was applied (n = 57 IIIa, n = 58 IIIb, n = 23 IIIc, n = 10 IV). Minor tears predominated. Minor and major tears differed in respect to birthweight (p = 0.047). N = 75 reported no sphincter function affection. Macrosomia compromised sphincter function (p = 0.008). Univariate analysis showed age (p < 0.001), male infants (p = 0.017) and higher parity (p = 0.013) to be risk factors. Symptomatic women had weaker pelvic floor muscle (p = 0.009) and suffered from urinary incontinence (p < 0.001). Multiple regression analysis showed an association of St. Mark’s Scores ≥ 5 with parity (CI 0.191–0.847, p = 0.016) and ≥ 10 with maternal age (CI 1.077–1.396, p = 0.002) and for urinary incontinence with birthweight (CI 1.000–1.002, p = 0.032 and St. Mark’s categories ((0–4, 5–9, > 10) CI 2.657–10.904, p = 0.005)).

Conclusion

Overall, Berlin’s medical care of OASI is based on guideline standards. Anal and urinary incontinence correlate. Parity and higher age are risk factors in developing severe anal symptoms.

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Funding

The authors have not disclosed any funding.

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Authors and Affiliations

  1. German Pelvic Floor Centre, Department of Urogynecology, St. Hedwigs Hospital, Große Hamburger Straße 5-11, 10115, Berlin, Germany

    Nadine Schwertner-Tiepelmann, Kathrin Beilecke, Juliane Marschke & Ralf Tunn

  2. Department of Nephrology and Medical Intensive Care, Charité University Hospital Benjamin Franklin, Berlin, Germany

    Karlotta Lorenz

  3. Institute for Hygiene and Environmental Health, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany

    Frank Schwab

Authors
  1. Nadine Schwertner-Tiepelmann
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  2. Karlotta Lorenz
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  3. Frank Schwab
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  4. Kathrin Beilecke
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  5. Juliane Marschke
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  6. Ralf Tunn
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Contributions

NS-T: protocol development, ethics, data analysis, manuscript writing. KL: data collection; FS: Data analysis, statistics; JM: manuscript editing; KB: data collection; RT: data collection, manuscript editing.

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Correspondence to Nadine Schwertner-Tiepelmann.

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Kathrin Beilecke is member of the guideline committee on OASI, the other authors state no conflict of interest.

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Schwertner-Tiepelmann, N., Lorenz, K., Schwab, F. et al. Berlin survey on obstetric anal sphincter injury (OASI). Arch Gynecol Obstet 306, 1117–1125 (2022). https://doi.org/10.1007/s00404-022-06627-9

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  • DOI: https://doi.org/10.1007/s00404-022-06627-9

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