Abstract
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.
Highlights
Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes
Rates of anal incontinence following the primary repair of obstetric anal sphincter injuries (OASIS) ranging from 15% to 60%, with an average of 39%, have been reported [5]. erefore, understanding the modifiable risk factors for OASIS is key in identifying interventions to prevent the occurrence of the perineal trauma and associated maternal complications
Is study aimed to determine the incidence and risk factors of OASIS among women delivering at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda
Summary
Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH). An obstetric anal sphincter injury (OASI) refers to thirdand fourth-degree perineal tears. Between 0.6% and 9.0% of women, who deliver vaginally, where mediolateral episiotomy is performed, sustain obstetric anal sphincter injuries (OASIS) [2]. Obstetric anal sphincter injuries cause significant morbidity including anal incontinence, rectovaginal fistula, and pain [1]. One of the most distressing immediate complications of perineal injury is perineal pain, which can result into urinary retention and Obstetrics and Gynecology International defecation problems in the immediate postpartum period. Rates of anal incontinence following the primary repair of OASIS ranging from 15% to 60%, with an average of 39%, have been reported [5]. erefore, understanding the modifiable risk factors for OASIS is key in identifying interventions to prevent the occurrence of the perineal trauma and associated maternal complications
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