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The consequences of undiagnosed obstetric anal sphincter injuries (OASIS) following vaginal delivery

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Abstract

Introduction and hypothesis

We aimed to compare anal and urinary incontinence symptoms and anal manometry between women with undiagnosed obstetric anal sphincter injuries (OASIS) and women who had OASIS diagnosed and repaired.

Methods

This was a matched retrospective cohort study. Each missed OASI was matched with a diagnosed OASI for severity [minor (3a/b) or major (3c)], parity and length of follow-up. Women completed the modified St Mark’s Incontinence Score and International Consultation on Incontinence Questionnaire. Women with OASIS or those without OASIS but with anal incontinence symptoms were seen in perineal clinic for perineal examinations, anorectal manometry and three-dimensional endoanal ultrasound 8–12 weeks postnatally or in a subsequent pregnancy.

Results

Forty missed OASIS were matched with 40 recognised OASIS (16 3a/b; 24 3c). The median modified St Mark’s scores were higher for missed tears [11 (4, 15) vs. 1 (0, 4), p < 0.001] as well as the urinary incontinence scores [4 (0, 6) vs. 0 (0, 2), p = 0.01] than for the control group. Missed OASIS patients had a shorter perineal body [1.6 ± 1.3 vs. 2.4 ± 0.8, p = 0.009]. All missed OASIS had larger defects on endoanal ultrasound. One in four missed OASIS required further surgery [aOR 4.1 (95% CI 1.0–16.3), p = 0.04] and almost all needed colorectal input [aOR 24.1 (95% CI 7.3–80.0), p < 0.0001]. There were no differences in anal manometry.

Conclusions

Women with symptomatic missed OASIS are compromised in terms of anal and urinary incontinence symptoms, sphincter defect size and perineal body size requiring additional colorectal input. This highlights the importance of preventing OASIS and perseverance with training to diagnose OASIS.

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Authors and Affiliations

  1. Croydon University Hospital, 530 London Road, London, CR7 7YE, UK

    Annika Taithongchai, Susana I. Veiga, Abdul H. Sultan & Ranee Thakar

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  1. Annika Taithongchai
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  2. Susana I. Veiga
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  3. Abdul H. Sultan
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  4. Ranee Thakar
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Correspondence to Ranee Thakar.

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Ranee Thakar is currently the President of the International Urogynecology Association. The other authors have no financial disclaimers or conflict of interest.

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Annual Meeting of the British Society of Urogynaecology, Royal College of Obstetricians and Gynaecologists, London 9 November 2018

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Taithongchai, A., Veiga, S.I., Sultan, A.H. et al. The consequences of undiagnosed obstetric anal sphincter injuries (OASIS) following vaginal delivery. Int Urogynecol J 31, 635–641 (2020). https://doi.org/10.1007/s00192-019-04033-5

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  • DOI: https://doi.org/10.1007/s00192-019-04033-5

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