E-Posters-Do Women who Sustain Grade 3a Obstetric Anal Sphincter Injuries (OASIS) Need Follow up in Perineal Clinic?

Do Women who Sustain Grade 3a Obstetric Anal Sphincter Injuries (OASIS) Need Follow up in Perineal Clinic? - Annika Taithongchai, MRCOG

Back to course

Pdf Summary

This study aimed to determine if the presence of anal incontinence symptoms can be used to determine the follow-up requirements of grade 3a anal sphincter tears. The researchers conducted a retrospective analysis of women with grade 3a tears seen 8-12 weeks postpartum from 2006-2016. The women completed a validated St Mark's Score for anal incontinence and an International Consultation on Incontinence Questionnaire (ICIQ-UI-SF) for urinary incontinence symptoms. Anorectal manometry and 3-dimensional endoanal ultrasound were also performed. <br /><br />The results showed that out of 391 women with grade 3a tears, 9.0% had an external anal sphincter (EAS) defect, 5.1% had an internal anal sphincter (IAS) defect, and 3.8% had both IAS and EAS defects. Those who were symptomatic for anal incontinence had a 3 times greater risk of an EAS defect. The number needed to investigate with endoanal ultrasound in asymptomatic women to detect one defect was 16, while in symptomatic women it was 5. The presence of anal incontinence symptoms was associated with reduced maximum squeeze pressure, low incremental rise on anorectal manometry, and EAS defects. <br /><br />The study concludes that there is a need for better training in the identification and repair of obstetric anal sphincter injuries (OASIs) as a significant number of women with grade 3a tears had persistent sphincter defects, suggesting misclassification of tear grade or suboptimal repair techniques. This information can be used to counsel women with grade 3a OASIs and guide resource allocation in perineal clinics. The study highlights the importance of considering anal incontinence symptoms when determining follow-up requirements for grade 3a anal sphincter tears.

Keywords

anal incontinence symptoms

grade 3a anal sphincter tears

follow-up requirements

retrospective analysis

St Mark's Score

International Consultation on Incontinence Questionnaire

anorectal manometry

3-dimensional endoanal ultrasound

obstetric anal sphincter injuries (OASIs)

perineal clinics