Spontaneous obstetric anal sphincter injury among nulliparous women with non-operative vaginal delivery: Modifiable risk factors?

Background: Anal incontinence is an embarrassing condition that is largely underreported. Obstetric anal sphincter injuries are the most important etiological factors. Anal sphincter injury during delivery is considered to be one of the major risk factors for fecal incontinence in women. After anal sphincter injury at the time of delivery, up to 50% women have complaints of fecal incontinence, mainly because of persisting sphincter defects. Objectives: To evaluate the risk factors for the occurrence of obstetric anal sphincter injuries during vaginal delivery. To evaluate the outcome of patients with obstetric anal sphincter injuries. Methodology: A retrospective descriptive study was conducted from 2014 to 2016. Data of all patients with Obstetric Anal Sphincter Injuries (OASIS) over 3 years was collected from the medical record section after ethical clearance from Institutional Review Committee (IRC), BPKIHS. The data was entered in the excel sheet and analyzed using SPSS 17. Results: The Most important risk factor of OASIS was operative vaginal delivery (vacuum assisted vaginal delivery), followed by birth weight of the baby greater than 3.5 Kg and primigravida. Conclusion: Patients undergoing operative vaginal delivery, primigravida and birth weight greater than 3 kg are the important risk factors for OASIS. So, patients with these conditions should be handled carefully during second stage of labor to prevent the occurrence of OASIS.

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Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population–based cohort study

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2013.08.043 ◽

2014 ◽

Vol 210 (1) ◽

pp. 59.e1-59.e6 ◽

Cited By ~ 71

Author(s):

Hanna Jangö ◽

Jens Langhoff-Roos ◽

Susanne Rosthøj ◽

Abelone Sakse

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Anal Sphincter ◽

Population Based ◽

Obstetric Anal Sphincter Injury ◽

Modifiable Risk Factors ◽

Sphincter Injury ◽

Anal Sphincter Injury ◽

Primiparous Women

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Modifiable and non-modifiable risk factors for obstetric anal sphincter injury in a Norwegian Region: A case-control study.

10.22541/au.161830970.09278320/v1 ◽

2021 ◽

Author(s):

Ragnhild Klokk ◽

Kjersti Bakken ◽

Trond Markestad ◽

Mads Holten-Andersen

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Anal Sphincter ◽

Case Control Study ◽

Case Control ◽

Obstetric Anal Sphincter Injury ◽

Modifiable Risk Factors ◽

Sphincter Injury ◽

Anal Sphincter Injury ◽

Control Study

Objective To identify modifiable and non-modifiable risk factors for severe obstetric anal sphincter injury (OASI) following vaginal delivery. Design Retrospective case-control study. Setting Single center maternity clinic in South-Eastern Norway Population Women diagnosed with OASI following singleton vaginal birth after 30 weeks’ gestation (n = 421) and matched controls (n = 421) during 1990-2002. Methods Data were extracted retrospectively from an institutional birth registry. For each woman with OASI the first subsequent vaginal singleton delivery matched for parity was elected as control. Potential determinants for OASI were assessed by conditional logistic regression analyses. Main outcome measure OASI, defined as 3rd or 4th degree obstetric anal sphincter lesions. Results Among modifiable factors amniotomy was the strongest independent determinant for OASI in both primi- (adjusted odds ratio [aOR] 4.84; 95% CI 2.60–9.02) and multiparous (aOR 3.76; 95% CI 1.45–9.76) women, followed by augmentation with oxytocin (primiparous: aOR 1.63; 95% CI 1.08–2.46, multiparous: aOR 3.70; 95% CI 1.79–7.67). Vacuum extraction and forceps delivery were independently associated with OASI in primiparous women (vacuum: aOR 1.91; 95% CI 1.03–3.57, forceps: aOR 2.37; 95% CI 1.14–4.92), and episiotomy for OASI in multiparous women (aOR 2.64; 95% CI 1.36–5.14). Conclusions Amniotomy may be a hitherto unrecognized independent modifiable risk factor for OASI and should be further investigated for its potential role in preventive strategies for OASI. Funding Innlandet Hospital Trust research fund, grant number 150434. Keywords Obstetric anal sphincter injury; OASI; Birth; Birth injury; Modifiable risk factor; Amniotomy.

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Obstetric anal sphincter injury in adolescent mothers

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04045-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Henry H. Chill ◽

Michal Lipschuetz ◽

Eyal Atias ◽

Tzvika Shimonovitz ◽

David Shveiky ◽

...

Keyword(s):

Risk Factors ◽

Vaginal Delivery ◽

Anal Sphincter ◽

Adolescent Mothers ◽

Head Circumference ◽

Obstetric Anal Sphincter Injury ◽

Age Group ◽

Adult Group ◽

Sphincter Injury ◽

Anal Sphincter Injury

Abstract Background Obstetric anal sphincter injury (OASI) is a debilitating complication of vaginal delivery which has yet to receive ample attention in adolescents. The aim of this study was to describe risk for OASI in adolescent mothers compared to adults. We further attempted to compare risk factors for OASI between these two age groups. Methods We performed a retrospective cohort study between 2003 and 2019. Primiparous women who delivered vaginally, 21 years and younger were compared to women ages 26–35. Excluded were preterm, multifetal, non-vertex, cesarean deliveries as well as intrauterine fetal death. Rate of OASI as well as obstetric and labor characteristics of women with OASI, were compared between groups. Finally, risk factors were assessed for each group separately. Univariate and multivariate logistic regression model were performed. Results Final analysis was performed on 5113 nulliparous adolescents and 13,845 nulliparous in the 26–35 age group. Allocation to study groups was according to OASI – Sixty-seven adolescents (1.3%) had a 3rd or 4th degree perineal tear and were defined as the OASI group, while 5046 patients (98.7%) did not have such a tear. In the adult group, 199 out of 13,845 patients (1.4%) were diagnosed with OASI. Occurrence of OASI did not differ between groups (p = 0.510). Comparison of women with OASI in the adolescent group vs. adult group found differences with regard to operative vaginal delivery, (20.9% vs. 36.2%, respectively; p = 0.023) and meconium stained amniotic fluid (9.1% vs. 21.3%, respectively; p = 0.027). Following multivariate analysis the only parameter independently associated with OASI in the adolescent age group was head circumference ≥ 90th percentile with an adjusted odds ratio of 3.08 (CI 1.48–6.38, p = 0.003). In the adult group the similar analysis revealed operative vaginal delivery (OR = 2.44, CI 1.72–3.47, p < 0.001) and a birthweight≥90th percentile (OR = 2.23, CI 1.19–4.18, p = 0.012) to be independent risk factors for OASI. Conclusion Adolescents have similar risk for OASI compared to adults but differ in risk factors leading to OASI. Head circumference ≥ 90th percentile was found to be associated with OASI in this age group.

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