Abstract
Objective: To determine if the application of guidelines for obstetrical anal sphincter injuries (OASIS) management adopted by professional society in a country improves healthcare compared to a country where the guidelines are not adopted. Materials and Methods: In 2008 and 2016, a questionnaire was sent to every maternity ward in the Czech and Slovak Republics. In 2011, the guidelines for OASIS management were published in the Czech Republic. The authors compared the changes in the management of OASIS in both countries and evaluated the effect of the guidelines on healthcare improvement. Results: In 2008, the current Royal College of Obstetricians and Gynaecologists (RCOG) classification of OASIS was not used by any hospital in both countries. In 2016, the classification was used by 48.8% of hospitals in the Czech Republic and by 11.5% of hospitals in the Slovak Republic. The percentage of hospitals in the Czech Republic which used antibiotic prophylaxis while treating OASIS increased from 87.3% in 2008 to 100% in 2016. In the Slovak Republic, the percentage decreased from 85.7% to 73.1%. Active follow-up increased in the Czech Republic from 40% to 70.8%. In the Slovak Republic, it increased from 33.3% to 38.5%. In 2008, the management according to EBM was not performed by any of centres participating in the survey. In 2016, this percentage increased to 34.1% in the Czech Republic and to 3.8% in the Slovak Republic. Conclusion: The introduction of guidelines improved healthcare more significantly compared to the country where guidelines are not yet adopted.
Highlights
Obstetrical anal sphincter injuries (OASIS) are the main risk factor of anal incontinence in young women [1]
In 2008, 55 (54%) maternity wards in the Czech Republic and 21 (41%) maternity wards in the Slovak Republic responded to the questionnaire
There is no experience in using monofilament absorbable suture materials in the treatment of obstetric injuries in both countries and braided vicryl is recommended
Summary
Obstetrical anal sphincter injuries (OASIS) are the main risk factor of anal incontinence in young women [1]. Women with acquired anal incontinence after giving birth often suffer from severe psychosocial morbidity. A permanent feeling of impurity can lead to loss of dignity, feeling of isolation, changes in everyday habits, and feelings of fear and anxiety. The occurrence of symptoms of anal incontinence depends on the quality of care [3]. This is the main reason why professional societies tend to accept guidelines for the management of OASIS [4, 5] and why workshops on the improvement of precise diagnostics and treatment of these injuries are organised in many countries [6, 7]
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