Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study
Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study
Introduction and hypothesis: Women with a history of obstetric anal sphincter injury (OASI) are at increased risk of recurrence (rOASI) at subsequent delivery; however, evidence regarding the factors influencing this risk is limited. Furthermore, little is known about what factors influence the decision to alternatively deliver by elective caesarean section (ELLSCS).
Methods: Retrospective univariate and multivariate logistic regression analysis of prospectively collected data from four NHS electronic maternity databases including primiparous women sustaining OASIS during a singleton, term, cephalic, vaginal delivery between 2004 and 2015, who had a subsequent delivery.
Results: Two thousand two hundred seventy-two women met the criteria; 10.2% delivering vaginally had a repeat OASI and 59.4% had a second-degree tear. Women having an ELLSCS were more likely to be Caucasian, older, have previously had an operative vaginal delivery (OVD) and have a more severe degree of OASI. Positive predictors for rOASI were increased birth weight and maternal age at both index and subsequent deliveries, a more severe degree of initial OASI and Asian ethnicity. The overall mediolateral episiotomy (MLE) rate was 15.6%; 77.2% of those who had an episiotomy sustained no spontaneous perineal trauma. Only 4.4% of women with a rOASI had an MLE, whilst the MLE rate was 16.9% in those without a recurrence (p < 0.001). MLE decreased the risk of rOASI by 80%. Birth weight > 4 kg increased the risk 2.5 fold.
Conclusions: Women with previous OASIS are at an increased risk of recurrence. A more liberal use of MLE during subsequent vaginal delivery could significantly reduce the risk of recurrence.
Mediolateral episiotomy, Obstetric anal sphincter injuries, Perineal trauma, Recurrent obstetric anal sphincter injury
1-7
D’Souza, Joanna Caroline
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Monga, Ash
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Tincello, Douglas G.
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Sultan, Abdul H.
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Thakar, Ranee
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Hillard, Timothy C.
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Grigsby, Stephanie
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Kibria, Ayisha
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Jordan, Clare F.
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Ashmore, Christopher
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D’Souza, Joanna Caroline
714419e4-b3a9-42cf-9838-913b880ced88
Monga, Ash
60b415bd-97b3-485b-b641-0751151036d3
Tincello, Douglas G.
6dcd9583-06ff-46f0-8e2c-c1fc338734d9
Sultan, Abdul H.
97c48af4-de0d-4d17-b19b-135336c95d25
Thakar, Ranee
a2e9310d-3b2d-4d29-a47b-d92a909f53c9
Hillard, Timothy C.
775763f5-c194-410c-88a9-7c404d788e8f
Grigsby, Stephanie
c5628da2-0b37-4dce-abfa-98b0856c2dcf
Kibria, Ayisha
584458b4-8817-4ca0-a0a9-a530b8bf39b4
Jordan, Clare F.
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Ashmore, Christopher
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D’Souza, Joanna Caroline, Monga, Ash, Tincello, Douglas G., Sultan, Abdul H., Thakar, Ranee, Hillard, Timothy C., Grigsby, Stephanie, Kibria, Ayisha, Jordan, Clare F. and Ashmore, Christopher
(2019)
Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study.
International Urogynecology Journal, .
(doi:10.1007/s00192-019-03983-0).
Abstract
Introduction and hypothesis: Women with a history of obstetric anal sphincter injury (OASI) are at increased risk of recurrence (rOASI) at subsequent delivery; however, evidence regarding the factors influencing this risk is limited. Furthermore, little is known about what factors influence the decision to alternatively deliver by elective caesarean section (ELLSCS).
Methods: Retrospective univariate and multivariate logistic regression analysis of prospectively collected data from four NHS electronic maternity databases including primiparous women sustaining OASIS during a singleton, term, cephalic, vaginal delivery between 2004 and 2015, who had a subsequent delivery.
Results: Two thousand two hundred seventy-two women met the criteria; 10.2% delivering vaginally had a repeat OASI and 59.4% had a second-degree tear. Women having an ELLSCS were more likely to be Caucasian, older, have previously had an operative vaginal delivery (OVD) and have a more severe degree of OASI. Positive predictors for rOASI were increased birth weight and maternal age at both index and subsequent deliveries, a more severe degree of initial OASI and Asian ethnicity. The overall mediolateral episiotomy (MLE) rate was 15.6%; 77.2% of those who had an episiotomy sustained no spontaneous perineal trauma. Only 4.4% of women with a rOASI had an MLE, whilst the MLE rate was 16.9% in those without a recurrence (p < 0.001). MLE decreased the risk of rOASI by 80%. Birth weight > 4 kg increased the risk 2.5 fold.
Conclusions: Women with previous OASIS are at an increased risk of recurrence. A more liberal use of MLE during subsequent vaginal delivery could significantly reduce the risk of recurrence.
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DSouza2019_Article_MaternalOutcomesInSubsequentDe
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Accepted/In Press date: 10 May 2019
e-pub ahead of print date: 22 June 2019
Keywords:
Mediolateral episiotomy, Obstetric anal sphincter injuries, Perineal trauma, Recurrent obstetric anal sphincter injury
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Local EPrints ID: 432451
URI: http://eprints.soton.ac.uk/id/eprint/432451
ISSN: 0937-3462
PURE UUID: d5b90a11-6d90-4b9e-b275-dc4e3d378b88
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Date deposited: 16 Jul 2019 16:30
Last modified: 16 Mar 2024 02:52
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Contributors
Author:
Joanna Caroline D’Souza
Author:
Ash Monga
Author:
Douglas G. Tincello
Author:
Abdul H. Sultan
Author:
Ranee Thakar
Author:
Timothy C. Hillard
Author:
Stephanie Grigsby
Author:
Ayisha Kibria
Author:
Clare F. Jordan
Author:
Christopher Ashmore
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