Abstract
BackgroundMost women choose to have another vaginal delivery following one complicated by an obstetrical anal sphincter injury (OASIS). However, little is known about patient satisfaction or regret with this decision. Therefore, our objective was to assess decisional regret with subsequent route of delivery following one affected by an OASIS.MethodsA survey study was conducted among women seen in a specialty postpartum perineal clinic at a tertiary teaching hospital following a vaginal delivery with an OASIS between March 2012 and December 2016 who also had a subsequent delivery during that time period. Women were mailed a 13-item questionnaire between June and October 2017 that addressed pelvic floor symptoms and regret with their decision regarding mode of subsequent delivery. Regret was assessed with a modified Decision Regret Scale. Bivariate analyses were used to compare women with no, mild, or moderate/severe regret.ResultsAmong 115 eligible women, 50 completed the survey. The majority (82%, n = 41) had a subsequent vaginal delivery and 18% (n = 9) had a subsequent cesarean delivery. Over one-third (34.9%, n = 15) reported the counseling they received after the OASIS influenced their decision regarding route of subsequent delivery. Fifty-four percent (n = 27) had no regret regarding their decision about subsequent delivery route, while 18 (36%) had mild, and five (10%) had moderate/severe regret. Regret was associated with older age (none: 36.8 ± 3.6 vs mild: 37.3 ± 3.4 vs moderate/severe: 41.7 ± 3.8 years, p = .03) and prevalence of fecal incontinence after delivery with OASIS (none: 15% vs mild: 17% vs moderate/severe: 80%, p = .01).ConclusionsMost women with an OASIS and a subsequent pregnancy will choose a repeat vaginal delivery, and over half have no regret about this decision. Older age and fecal incontinence following the incident delivery with OASIS were associated with regret regarding subsequent delivery mode.
Highlights
Most women choose to have another vaginal delivery following one complicated by an obstetrical anal sphincter injury (OASIS)
Women were included if all of the following criteria were met: 1) prior vaginal delivery complicated by Obstetrical anal sphincter injury (OASIS), referred to as the “incident” delivery, 2) evaluation in the Michigan Healthy Healing After Delivery (MHHAD) clinic following the incident delivery, and 3) subsequent pregnancy and delivery (“subsequent” delivery)—all between March 2012 and December 2016
All women had an OASIS with the incident delivery; 82% (41/50) had a third-degree laceration and 18% (9/50) had a fourth-degree laceration
Summary
Most women choose to have another vaginal delivery following one complicated by an obstetrical anal sphincter injury (OASIS). In 2018, The American College of Obstetricians and Gynecologists published new guidelines for optimizing postpartum care [1] In this committee opinion, they emphasize the importance of postpartum counseling regarding any complications that occurred during pregnancy or delivery and implications of those complications for future pregnancies. Subsequent VD following a delivery with an OASIS has been shown to worsen pelvic floor symptoms [6] Despite these data, 65% of women still choose to have another VD following one with an OASIS [3]. 65% of women still choose to have another VD following one with an OASIS [3] Patient satisfaction with this decision is unknown, which is a significant knowledge gap when it comes to counseling women on mode of delivery following an OASIS
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