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Risk factors for obstetric anal sphincter injury among parous women

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Nulliparity and operative vaginal delivery are established risk factor for obstetric anal sphincter injury (OASI). However, risk factors for OASIS occurrence among parous women delivering vaginally are not well-established. We aimed to study the risk factors for OASI occurrence among parous women.

Methods

A retrospective study including all parous women who delivered vaginally at term during 2011–2019 at a university hospital. Deliveries of parous women with OASI were compared to deliveries without OASI. The risk factors associated with OASI were investigated.

Results

Overall, 35,397 women were included in the study with an OASI rate of 0.4% (n = 144). A higher rate of only one previous vaginal delivery was noted in the OASI group (78.5% vs. 46.4%, OR [95% CI] 4.20, 2.82–6.25, p < 0.001). The rate of vacuum-assisted deliveries was comparable between the study groups. The median birth weight was higher among the OASI group (3566 vs. 3300 g, p < 0.001), as was the rate of macrosomic neonates (19.4% vs. 5.5%, OR [95% CI] 4.15, 2.74–6.29, p < 0.001). On multivariate logistic regression analysis, only two factors were independently positively associated with the occurrence of OASI: a history of only one previous vaginal delivery (adjusted OR [95% CI] 4.34, 2.90–6.49, p = 0.001), and neonatal birth-weight (for each 500 g increment) (adjusted OR [95% CI] 2.51, 1.84–3.44, p < 0.001).

Conclusions

Among parous women, the only factors found to be independently positively associated with OASI were the order of parity and neonatal birth-weight. Vacuum-assisted delivery was not associated with an increased risk of OASI among parous women.

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Abbreviations

OASI:

Obstetric anal sphincter injury

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Funding

No external funding was used in this conduct of this study.

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Author notes

  1. Gabriel Levin and Amihai Rottenstreich equal contribution.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel

    Gabriel Levin & Amihai Rottenstreich

  2. The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Abraham Tsur, Tal Cahan, Rakefet Yoeli-Ullman, Daniel Shai & Raanan Meyer

Authors
  1. Gabriel Levin
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  2. Amihai Rottenstreich
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  3. Abraham Tsur
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  4. Tal Cahan
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  5. Rakefet Yoeli-Ullman
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  6. Daniel Shai
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  7. Raanan Meyer
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Contributions

All authors contributed to the manuscript. GL, RM and AR reviewed the literature and wrote the paper. DS, RYU, AT performed the procedures and collected the data. All authors read and approved the final manuscript.

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Correspondence to Gabriel Levin.

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For this type of study formal consent is not required and was waived by the institutional review board approval. 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.

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Levin, G., Rottenstreich, A., Tsur, A. et al. Risk factors for obstetric anal sphincter injury among parous women. Arch Gynecol Obstet 303, 709–714 (2021). https://doi.org/10.1007/s00404-020-05806-w

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  • DOI: https://doi.org/10.1007/s00404-020-05806-w

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