Conference Proceedings - Gynecology and Reproductive Endocrinology (2021) Volume 5, Issue 0

Service evaluation of management of Obstetric Anal Sphincter Injuries

Objective: Obstetric Anal Sphincter Injuries (OASI) complicates 1.7-18% of vaginal deliveries (VD) [1]. Most women (60?80%) become asymptomatic within a year [2] but run the risk of recurrence in future VDs besides long-term anal/fecal incontinence with severe tears [3]. The Royal College of Obstetricians and Gynaecologists (RCOG) introduced a care bundle, recommending better communication with women, revisiting the role of episiotomy, the importance of manual perineal protection (MMP) and the significance of post-partum rectal examination. Consequently, a service-development project was conducted in our unit to assess our compliance to the national recommendations [2,4]. Method: Retrospective audit, in a district hospital, examining OASI incidents over a sixmonth period (01/01/2020- 30/06/2020) and used the RCOG standards [2]. Results: Among 516 VD, 29 (5.6%) sustained OASI (Table 1). Most women were primiparous (n=22; 75.9%) and spontaneous VD (SVD). 5 (17.9%) had an episiotomy and 6 (20.7%) received MMP. All tears were diagnosed and repaired by the on-call registrars and all the surgical and post-operative plans have been identical in every case. There was a positive correlation between the mode of delivery and the length of both labour stages, first (Spearman?s; r=0.39, p= 0,04) and second (r=0.43, p= 0.02). Neither the maternal nor fetal weights influenced the delivery mode (Figure 1.) Discussion: The OASI incidence was higher than the national average (2.9%)[2]. Managements followed the guidelines, while improvement was required in the preventative strategies. Interestingly, most OASI were associated with primiparity and SVD, something already advocated in recent literature [5]. Understandably, the OASI bundle was put into practice and special training was offered to all clinical staff in order to familiarise themselves with its elements. Conclusions: OASI remains a common obstetric complication but evidence suggests that with proper preventative methods and thorough management the incidences can be reduced and the complications avoided.

Author(s): Karyna Trull

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