Management Of Obstetric Anal Sphincter Injury Research Articles

UK survey of colorectal surgeons on the management of acute obstetric anal sphincter injuries.

The role of colorectal surgeons in the management of acute obstetric anal sphincter injury (OASI) is an ongoing debate. Their expertise in operating in the anorectal region lends itself to assisting in OASI repair. The aim of this study was to establish the current involvement and recommended management of acute OASI by colorectal surgeons. An online survey of consultant colorectal surgeons was sent to members of the Pelvic Floor Society to assess current involvement in acute OASI management and repair. Forty completed surveys were collated and analysed. Sixty-five per cent of respondents had seen an acute OASI since being a consultant and 50% stated they were involved in the repair of OASI less than once per year. 37.5% felt that a de-functioning stoma was still necessary sometimes. Many agreed with current guidelines for OASI repair in terms of antibiotics, laxatives and follow-up. Colorectal surgeons have varied opinions on the management of OASI. We suggest that multidisciplinary training of obstetricians and colorectal surgeons could lead to more collaboration regarding the management of women with acute OASI.

Obstetric anal sphincter injuries: strategies for prevention, diagnosis, and management.

Obstetric anal sphincter injuries (OASIS) are one of the most common causes of anal incontinence (AI) in women of reproductive age and can have a significant impact on quality of life. However, many women do not report symptoms to their physicians because of embarrassment and shame. Therefore, prevention and diagnosis of the tear is essential. Diagnostic strategies have evolved considerably in recent years, with an increase in prevalence of OASIS as a consequence. The use of 3D endoanal (3D-EAUS) and 4D transperineal ultrasound (4D-TPUS), in addition to standard clinical examination have enhanced the detection of OASIS. Once identified, adequate repair by a skilled practitioner and optimal postpartum management should be ensured in order to reduce the risk of anal incontinence. This review presents the available evidence on strategies for prevention, diagnosis, and management of OASIS.

Welcome to ANZJOG 2021

Welcome to ANZJOG 2021

Establishing a peripartum perineal trauma clinic: a narrative review.

Obstetric anal sphincter injury (OASI) is not rare, and its consequences are multiple and potentially severe, especially for young women. Some dedicated perineal clinics have been established to improve the management of OASI. Despite their obvious importance, these specific clinics are underrepresented and underdeveloped. The objectives of this review are to explore various options for developing a peripartum perineal clinic and to compare the different practices regarding the mode of delivery for subsequent pregnancies after an OASI. This narrative review covers information from patients' questionnaires specific to anal incontinence, anal physiology assessment, pelvic floor and anal sphincter imaging, and the arguments for choosing the mode of delivery after an OASI. This review highlights the extensive range of practices regarding the delivery mode after an OASI throughout national professional organizations and experienced perineal clinics. This review summarizes the different choices in developing a perineal clinic to facilitate their development in promoting health care and education specific for peripartum women concerning the perineal consequences of delivery for obstetrician-gynaecologists, family doctors, and residents.

Management of obstetric anal sphincter injury: Colorectal surgeons' perspectives in Australia and New Zealand.

Obstetric anal sphincter injuries (OASIs) are a significant complication of vaginal delivery, and a leading cause of anal incontinence in women. The aims were to explore the management of OASIs in Australia and New Zealand (ANZ) by colorectal surgeons and how this compares with current recommendations and international experience, and to identify the deterrents to the provision of best-practice care among colorectal surgeons. Three hundred colorectal surgeons of the Colorectal Surgical Society of ANZ were mailed questionnaires. Areas of interest included: surgeon demographics; exposure to OASIs; understanding of current recommendations; and opinions regarding the importance of symptoms and assessment tools in OASIs. There were 94 completed questionnaires (response rate 31.3%). Fifty-seven surgeons (60.6%) reported low exposure to OASIs during their fellowship training. Greater than 90% believed patients with grade three tears and above should have anal sphincter assessment. Sixty-six (70.2%) reported that they routinely review women who have had OASIs. However, 56.4% were unaware if their obstetrics department followed a standard protocol for OASIs. Surgeons practising in metropolitan centres reported higher rates of their obstetrics department following a protocol (P=0.013), and greater access to investigative tools (P<0.001), when compared to rural-based surgeons. Most ANZ colorectal surgeons have had minimal training in OASI management. Colorectal surgeons are more commonly involved with OASI patients in the non-acute setting. Management protocols involving a multidisciplinary team of both colorectal surgeons and obstetricians should be clearly defined, and the gap between metropolitan and rural centres needs to be reviewed.

Obstetric Anal Sphincter Injuries at Vaginal Delivery: A Review of Recently Published National Guidelines.

Obstetric anal sphincter injuries (OASISs) complicate approximately 1 in 10 deliveries. The aims of this study were to review and compare recommendations from recently published national guidelines regarding OASISs at vaginal delivery. Three national guidelines on OASISs at vaginal delivery are presented through a descriptive review: Royal College of Obstetricians and Gynaecologists on "The Management of Third- and Fourth-Degree Perineal Tears," American College of Obstetricians and Gynecologists on "Prevention and Management of Obstetric Lacerations at Vaginal Delivery," and Society of Obstetricians and Gynaecologists of Canada on "Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair." These guidelines were summarized and compared in terms of prevention and management of OASISs. Quality of evidence was also reviewed based on method of reporting for each guideline. This published evidence reflects the differences between the national recommendations on the prevention and management of OASISs. Especially, as for the prevention of OASIS, routine use of episiotomy is not recommended, whereas warm perineal compresses and perineal massage during the second stage of labor seem to have a protective role. In the management of OASIS, special care is needed during the repair process of the torn anorectal mucosa and the internal and external anal sphincter. The postoperative use of broad-spectrum antibiotics, oral laxatives, and analgesia is also recommended. Summarized guidelines can have an impact on special care in prevention and management of OASIS; this may support the reduction of morbidity associated with that entity.

Obstetric anal sphincter injury audit at Borders general hospital (2004-2009)

IntroductionObstetric anal sphincter injury (OASI) is the most common cause of anal incontinence among women of childbearing age. OASI causes significant maternal morbidity in the postpartum period. Overall reported risk...

Structured hands-on training in repair of obstetric anal sphincter injuries (OASIS): an audit of clinical practice

We conducted an audit to evaluate how effective a structured course in the management of obstetric anal sphincter injuries (OASIS) was at imparting knowledge. Training was undertaken using models and cadaveric pig's anal sphincters. An anonymous questionnaire was completed prior to and 8 weeks after the course. Four hundred and ninety seven completed the questionnaire before and 63% returned it after the course. Prior to the course, participants performed on average 14 OASIS repairs independently. Only 13% were satisfied with their level of experience prior to performing their first unsupervised repair. After the course, participants classified OASIS more accurately and changed to evidence-based practice. Particularly, there was a change in identifying (60% vs. 90%; P < 0.0001) and repairing the internal sphincter (60% vs. 90%; P < 0.0001). This audit demonstrated that training in the management of OASIS is suboptimal. Structured training may be effective in changing clinical practice and should be an adjunct to surgical training.