Article ; Online: Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study.
International urogynecology journal
2019 Volume 31, Issue 3, Page(s) 627–633
Abstract: Introduction and hypothesis: Women with a history of obstetric anal sphincter injury (OASI) are at increased risk of recurrence (rOASI) at subsequent delivery; however, evidence regarding the factors influencing this risk is limited. Furthermore, little ...
| Abstract | Introduction and hypothesis: Women with a history of obstetric anal sphincter injury (OASI) are at increased risk of recurrence (rOASI) at subsequent delivery; however, evidence regarding the factors influencing this risk is limited. Furthermore, little is known about what factors influence the decision to alternatively deliver by elective caesarean section (ELLSCS). Methods: Retrospective univariate and multivariate logistic regression analysis of prospectively collected data from four NHS electronic maternity databases including primiparous women sustaining OASIS during a singleton, term, cephalic, vaginal delivery between 2004 and 2015, who had a subsequent delivery. Results: Two thousand two hundred seventy-two women met the criteria; 10.2% delivering vaginally had a repeat OASI and 59.4% had a second-degree tear. Women having an ELLSCS were more likely to be Caucasian, older, have previously had an operative vaginal delivery (OVD) and have a more severe degree of OASI. Positive predictors for rOASI were increased birth weight and maternal age at both index and subsequent deliveries, a more severe degree of initial OASI and Asian ethnicity. The overall mediolateral episiotomy (MLE) rate was 15.6%; 77.2% of those who had an episiotomy sustained no spontaneous perineal trauma. Only 4.4% of women with a rOASI had an MLE, whilst the MLE rate was 16.9% in those without a recurrence (p < 0.001). MLE decreased the risk of rOASI by 80%. Birth weight > 4 kg increased the risk 2.5 fold. Conclusions: Women with previous OASIS are at an increased risk of recurrence. A more liberal use of MLE during subsequent vaginal delivery could significantly reduce the risk of recurrence. |
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| MeSH term(s) | Anal Canal ; Cesarean Section/adverse effects ; Delivery, Obstetric/adverse effects ; Episiotomy/adverse effects ; Female ; Humans ; Obstetric Labor Complications/epidemiology ; Obstetric Labor Complications/etiology ; Pregnancy ; Retrospective Studies ; Risk Factors |
| Language | English |
| Publishing date | 2019-06-22 |
| Publishing country | England |
| Document type | Journal Article |
| ZDB-ID | 1050631-7 |
| ISSN | 1433-3023 ; 0937-3462 |
| ISSN (online) | 1433-3023 |
| ISSN | 0937-3462 |
| DOI | 10.1007/s00192-019-03983-0 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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