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Obstetric anal sphincter injury risk reduction: a retrospective observational analysis

  • Veluppillai Vathanan EMAIL logo , Oliparambil Ashokkumar und Trixie McAree
Veröffentlicht/Copyright: 1. April 2014

Abstract

Objective: To identify the risks of sustaining obstetric anal sphincter injury (OASI) during childbirth.

Methods: Data were analysed from 12,612 vaginal deliveries recorded at Northwick Park District General Hospital, London, from 1 January 2006 to 30 November 2009.

Results: A total of 85.6% were spontaneous deliveries and 14.2% were instrument deliveries. The majority (64.5%) sustained some form of perineal damage, 3.7% being OASI. Logistic regression analyses revealed the risk factors for OASI to be Asian ethnicity [odds ratio (OR) 4.798, 95% confidence interval (CI) 2.998–7.679], a maternal age of >40 years (OR 2.722, 95% CI 1.315–5.636), higher foetal birth weight (>4500 g; OR 6.228, 95% CI 2.695–14.392), lower parity (para 0; OR 16.803, 95% CI 7.697–36.685), and instrumental delivery. Forceps delivery posed the greatest risk (OR 8.4, 95% CI 5.822–12.151). Not having an episiotomy increased the risk of OASI by five times compared with having one.

Conclusions: Risk factors for OASI include maternal age >40 years, higher foetal birth weight, lower parity, instrumental delivery, and Asian ethnicity. Mediolateral episiotomy appears to reduce the risk of OASI. Specific variables have been identified for incorporation into a risk-reduction strategy that could be introduced antenatally to evaluate and assess OASI risk.


Corresponding author: Veluppillai Vathanan, MRCOG, Department of Obstetrics and Gynaecology, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, London, UK, Tel.: +44 0787 6024485, E-mail:

Acknowledgements

We are grateful to Mr Spence Jones, FRCOG, consultant obstetrician and gynaecologist, for his valuable comments on the manuscript. We are also grateful to Ms Elizabeth Wiredu, medical statistician, Data Solutions, for her input into the statistical analysis.

Conflict of interest statement

Authors’ conflict of interest disclosure: None.

Contribution to authorship: VV contributed to the conception, planning, carrying out, analysing, and writing up of this study. OA provided expert advice, writing up, and critical revision of the manuscript. TM identified, extracted the data for analysis, and critically revised the manuscript. All authors reviewed and approved the final version.

Funding: None.

References

[1] Bick DE, Kettle C, Macdonald S, Thomas PW, Hills RK, Ismail KMK. PErineal Assessment and Repair Longitudinal Study (PEARLS): protocol for a matched pair cluster trial. BMC Pregnancy Childbirth 2010;10:10.10.1186/1471-2393-10-10Suche in Google Scholar PubMed PubMed Central

[2] Carroli G, Belizan J. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2009;CD000081.10.1002/14651858.CD000081.pub2Suche in Google Scholar PubMed PubMed Central

[3] Christiansen LM, Bovbjerg VE, McDavitt EC, Hullfish KL. Risk factors for perineal injury during delivery. Am J Obstet Gynecol. 2003;189:255–60.10.1067/mob.2003.547Suche in Google Scholar PubMed

[4] de Leeuw JW, Struijk PC, Vierhout ME, Wallenburg HC. Risk factors for third degree perineal ruptures during delivery. BJOG 2001;108:383–7.Suche in Google Scholar

[5] Dudding TC, Vaizey CJ, Kamm MA. Obstetric anal sphincter injury incidence, risk factors, and management. Ann Surg. 2008;247:224–37.10.1097/SLA.0b013e318142cdf4Suche in Google Scholar PubMed

[6] Dudley NJ. A systematic review of the ultrasound estimation of fetal weight. Ultrasound Obst Gynecol. 2005;25:80–89.10.1002/uog.1751Suche in Google Scholar PubMed

[7] Fernando RJ, Sultan AH, Kettle C, Thakar R, Radley S. Methods of repair for obstetric anal sphincter injury (review). Cochrane Database of Systematic Reviews. 2006;19:1–29.Suche in Google Scholar

[8] Fernando RJ, Sultan AH, Radley S, Jones PW, Johanson RB. Management of obstetric anal sphincter injury: a systematic review & national practice survey. BMC Health Serv Res. 2002;2:1–10.10.1186/1472-6963-2-9Suche in Google Scholar PubMed PubMed Central

[9] Fowler GE. Obstetric anal sphincter injury. J Assoc Chart Physiother Womens Health 2009;104:12–9.Suche in Google Scholar

[10] Goldberg J, Hyslop T, Tolosa JE, Sultana C. Racial differences in severe perineal lacerations after vaginal delivery. Am J Obstet Gynecol. 2003;188:1063–7.10.1067/mob.2003.251Suche in Google Scholar PubMed

[11] Hals E, Oian P, Pirhonen T, Gissler M, Hjelle S, Nilsen EB, et al. A multicenter interventional program to reduce the incidence of anal sphincter tears. Obstet Gynecol. 2010;116:901–8.10.1097/AOG.0b013e3181eda77aSuche in Google Scholar PubMed

[12] Hopkins LM, Caughey AB, Glidden DV, Laros RK. Racial/ethnic differences in perineal, vaginal and cervical lacerations. Am J Obstet Gynecol. 2005;193:455–9.10.1016/j.ajog.2004.12.007Suche in Google Scholar PubMed

[13] Howard D, Davies PS, Delancey JO, Small Y. Differences in perineal lacerations in black and white primiparas. Obstet Gynecol. 2000;96:622–4.Suche in Google Scholar

[14] Johanson RB, Menon V. Vacuum extraction versus forceps for assisted vaginal delivery. Cochrane Database Syst Rev. 1999;CD000224.10.1002/14651858.CD000224Suche in Google Scholar PubMed

[15] Kumar R, Ooi C, Nicoll A. Anal incontinence and quality of life following obstetric anal sphincter injury. Arch Gynecol. 2012;285:591–7.10.1007/s00404-011-2003-xSuche in Google Scholar PubMed

[16] Laine K, Gissler M, Pirhonen J. Changing incidence of anal sphincter tears in four Nordic countries through the last decades. Eur J Obst Gynec Reprod Biol. 2009;146:71–5.10.1016/j.ejogrb.2009.04.033Suche in Google Scholar PubMed

[17] Nazir M, Carlsen E, Nesheim BI. Do occult anal sphincter injuries, vector volume manometry and delivery variables have any predictive value for bowel symptoms after first time vaginal delivery without third and fourth degree rupture? A prospective study. Acta Obstet Gynecol Scand. 2002; 81:720–6.10.1034/j.1600-0412.2002.810806.xSuche in Google Scholar PubMed

[18] Pinta TM, Kylanpaa ML, Salmi TK, Teramo KA, Luukkonen PS. Primary sphincter repair: are the results of the operation good enough? Dis. Colon Rectum. 2004;47:18–23.10.1007/s10350-003-0006-9Suche in Google Scholar PubMed

[19] Räisänen S, Vehviläinen-Julkunen K, Gissler M, Heinonen S. The increased incidence of obstetric anal sphincter rupture – An emerging trend in Finland. Prev Med. 2009;49:<softenter;535–40.10.1016/j.ypmed.2009.10.005Suche in Google Scholar PubMed

[20] Revicky V, Nirmal D, Mukhopadhyay S, Morris EP, Nieto JJ. Could a mediolateral episiotomy prevent obstetric anal sphincter injury? Eur J Obst Gynecol Reprod Biol. 2010;150:142–6.10.1016/j.ejogrb.2010.03.002Suche in Google Scholar PubMed

[21] Royal College of Obstetrics and Gynaecology, RCOG. Operative vaginal delivery. Green Top Guideline No. 26. Jan 2011.Suche in Google Scholar

[22] Royal College of Obstetrics and Gynaecology, RCOG. The management of third and fourth degree perineal tears. Green Top Guideline No. 29. 2007.Suche in Google Scholar

[23] Scheer I, Andrews V, Thakar R, Sultan A H. Urinary incontinence after obstetric anal sphincter injuries (OASIS)—is there a relationship? Int Urogynecol J. 2008;19:179–83.10.1007/s00192-007-0431-8Suche in Google Scholar PubMed

[24] Sultan AH, Kamm MA, Hudson CN, Bartram CI. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. Br Med J. 1994;308:887–91.10.1136/bmj.308.6933.887Suche in Google Scholar PubMed PubMed Central

[25] Thacker SB, Banta HD. Benefits and risks of episiotomy: an interpretative review of the English language literature, 1860–1980. Obstet Gynaecol Surv. 1983;38:322–38.10.1097/00006254-198306000-00003Suche in Google Scholar

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2013-10-2
Accepted: 2014-3-6
Published Online: 2014-4-1
Published in Print: 2014-11-1

©2014 by De Gruyter

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