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      Obstetric Anal Sphincter Injuries (OASIs) in Israel: A Review of the Incidence and Risk Factors

      review-article
      Author(s): , M.D. * , , M.D., , M.D., , M.D., , M.D.
      Editor(s): , M.D., M.S., M.H.A., , M.D., , M.D.
      Publication date (Electronic):
      Journal: Rambam Maimonides Medical Journal
      Publisher: Rambam Health Care Campus
      Keywords: Israel, OASIs, workshop

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          Abstract

          Obstetric anal sphincter injuries (OASIs) following vaginal deliveries are the main reason for subsequent development of anal incontinence in women. The diagnosis of such tears is crucial for treating and preventing such a grave sequela. The reported rate of OASIs in Israel was between 0.1% and 0.6%, out of all vaginal births, which is 10-fold lower than that reported in Europe and the United States. Structured hands-on training in repair of OASIs in seven medical centers in Israel significantly increased the detection rate of third-degree perineal tears. The implementation of such programs is crucial for increasing awareness and detection rates of OASIs following vaginal deliveries.

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          Obstetric anal sphincter injury: incidence, risk factors, and management.

          Michael Kamm, Thomas Dudding, Carolynne J Vaizey (2008)
          Obstetric sphincter damage is the most common cause of fecal incontinence in women. This review aimed to survey the literature, and reach a consensus, on its incidence, risk factors, and management. This systematic review identified relevant studies from the following sources: Medline, Cochrane database, cross referencing from identified articles, conference abstracts and proceedings, and guidelines published by the National Institute of Clinical Excellence (United Kingdom), Royal College of Obstetricians and Gynaecologists (United Kingdom), and American College of Obstetricians and Gynecologists. A total of 451 articles and abstracts were reviewed. There was a wide variation in the reported incidence of anal sphincter muscle injury from childbirth, with the true incidence likely to be approximately 11% of postpartum women. Risk factors for injury included instrumental delivery, prolonged second stage of labor, birth weight greater than 4 kg, fetal occipitoposterior presentation, and episiotomy. First vaginal delivery, induction of labor, epidural anesthesia, early pushing, and active restraint of the fetal head during delivery may be associated with an increased risk of sphincter trauma. The majority of sphincter tears can be identified clinically by a suitably trained clinician. In those with recognized tears at the time of delivery repair should be performed using long-term absorbable sutures. Patients presenting later with fecal incontinence may be managed successfully using antidiarrheal drugs and biofeedback. In those who fail conservative treatment, and who have a substantial sphincter disruption, elective repair may be attempted. The results of primary and elective repair may deteriorate with time. Sacral nerve stimulation may be an appropriate alternative treatment modality. Obstetric anal sphincter damage, and related fecal incontinence, are common. Risk factors for such trauma are well recognized, and should allow for reduction of injury by proactive management. Improved classification, recognition, and follow-up of at-risk patients should facilitate improved outcome. Further studies are required to determine optimal long-term management.
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            Practice Bulletin No. 165: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.

            (2016)
            Lacerations are common after vaginal birth. Trauma can occur on the cervix, vagina, and vulva, including the labial, periclitoral, and periurethral regions, and the perineum. Most of these lacerations do not result in adverse functional outcomes. Severe perineal lacerations, extending into or through the anal sphincter complex, although less frequent, are more commonly associated with increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction with symptoms that may persist or be present many years after giving birth. The purpose of this document is to provide evidence-based guidelines for the prevention, identification, and repair of obstetric lacerations and for episiotomy.
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              Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population-based cohort study.

              Susanne Rosthøj, Hanna Jangö, Jens Langhoff-Roos … (2013)
              To determine modifiable risk factors and incidence of obstetric anal sphincter injury (OASIS) in primiparous women. We performed a population-based retrospective cohort study, using data from the Danish Medical Birth Registry. The population consisted of primiparous women with a vaginal delivery in the time period 2000-2010. Univariable and multivariable logistic regressions were used to determine risk factors of OASIS. Main outcome measures were incidence of OASIS in first vaginal delivery, odds ratios for possible risk factors: age, body mass index, birthweight, head circumference, gestational age, presentation, induction of labor, oxytocin augmentation, epidural, mediolateral episiotomy, vacuum extraction, forceps, shoulder dystocia, and year of delivery. Of 214,256 primiparous women with a vaginal delivery, 13,907 (6.5%; 95% confidence interval [CI] 6.4-6.6%) experienced an OASIS. The incidence of OASIS increased in the time period (adjusted odds ratio [aOR], 1.02; 95% CI, 1.02-1.03; P < .0001, per year). We found a protective effect of epidural analgesia (aOR, 0.84; 95% CI, 0.81-0.88; P = .0001). Vacuum extraction without episiotomy was a significant risk factor of OASIS (aOR, 2.99; 95% CI, 2.86-3.12; P < .0001), and episiotomy was protective in vacuum-assisted deliveries compared with vacuum-assisted deliveries without episiotomy (aOR, 0.60; 95% CI, 0.56-0.65; P < .0001). Birthweight was found to be an important nonmodifiable risk factor (aOR, 2.76; 95% CI, 2.62-2.90; P < .0001). Epidural analgesia in itself was protective against OASIS. Vacuum extraction increased the risk of OASIS, although mediolateral episiotomy was protective when applied in deliveries assisted by vacuum extraction. Copyright © 2014 Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Rambam Maimonides Med J
                Journal ID (iso-abbrev): Rambam Maimonides Med J
                Journal ID (publisher-id): RMMJ
                Title: Rambam Maimonides Medical Journal
                Publisher: Rambam Health Care Campus
                ISSN (Electronic): 2076-9172
                Publication date Collection: April 2017
                Publication date (Electronic): 28 April 2017
                Volume: 8
                Issue: 2
                Electronic Location Identifier: e0018
                Affiliations
                Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
                Author notes
                [* ]To whom correspondence should be addressed. E-mail: ginath@ 123456gmail.com
                Article
                Publisher ID: rmmj-8-2-e0018
                DOI: 10.5041/RMMJ.10295
                PMC ID: 5415364
                PubMed ID: 28467760
                SO-VID: 787c0eca-c4c7-48e2-8e3e-c623cb465d0a
                Copyright © © 2017 Ginath et al.
                License:

                This is an open-access article. All its content, except where otherwise noted, is distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Special Issue on Gynecology, Fertility, and Obstetrics
                Subject: Gynecology: Review

                Keywords: israel,oasis,workshop
                Data availability:
                Keywords: israel, oasis, workshop

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