Anal Sphincter Damage After Vaginal Delivery

ABSTRACTThe professional literatures on the development of widely practiced procedure, episiotomy through theyears from the first publication in 1742 are reviewed. It reveals the change in number of publication as wellas the contributors to the development of perception about episiotomy. So it consisted expression of opinionof doctors initially then the co-workers like nurses and researchers and clients or consumers themselvestoo. It concludes that episiotomies prevent anterior perineal tear but fails to accomplish other benefitstraditionally ascribed to pelvic floor damage and relaxation including its sequel and also protection ofnewboin from intracranial haemorrhage and intrapartum asphyxia. Episiotomy substantially increasematernal blood loss during delivery and risk of anal sphincter damage with their long term morbidity.There is an urgent need to restrict the use of episiotomy in vaginal delivery.Key Words: Episiotomy, Perineal tear, anal sphincter damage.

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Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda

Obstetrics and Gynecology International ◽

10.1155/2020/6035974 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Mahad Ali ◽

Richard Migisha ◽

Joseph Ngonzi ◽

Joy Muhumuza ◽

Ronald Mayanja ◽

...

Keyword(s):

Risk Factors ◽

Vaginal Delivery ◽

Anal Sphincter ◽

Tertiary Hospital ◽

Monthly Income ◽

Obstetric Anal Sphincter Injuries ◽

Perineal Tear ◽

Fourth Degree ◽

Anal Sphincter Injury ◽

Second Stage Of Labour

Background. Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS. Objectives. To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH). Methods. We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants’ medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors. Results. The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2nd stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86–19.82, p=0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07–6.17, p=0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01–0.12, p<0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03–0.28, p<0.001). Conclusions and Recommendations. The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.

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