scholarly journals Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mahad Ali ◽  
Richard Migisha ◽  
Joseph Ngonzi ◽  
Joy Muhumuza ◽  
Ronald Mayanja ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Tertiary Hospital ◽  
Monthly Income ◽  
Obstetric Anal Sphincter Injuries ◽  
Perineal Tear ◽  
Fourth Degree ◽  
Anal Sphincter Injury ◽  
Second Stage Of Labour

Background. Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS. Objectives. To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH). Methods. We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants’ medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors. Results. The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2nd stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86–19.82, p=0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07–6.17, p=0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01–0.12, p<0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03–0.28, p<0.001). Conclusions and Recommendations. The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.

scholarly journals Risk Factors and Outcome of Patients with Obstetric Anal Sphincter Injuries (OASIS)

2018 ◽  
Vol 1 (2) ◽  
pp. 69-72
Author(s):  
Rabindra D. Bhatt ◽  
S. Sitaula ◽  
T. Pradhan ◽  
T. Manandhar ◽  
T. Basnet
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Fecal Incontinence ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Obstetric Anal Sphincter Injuries ◽  
Sphincter Injury ◽  
Second Stage Of Labor ◽  
Anal Sphincter Injury ◽  
Operative Vaginal Delivery

Background: Anal incontinence is an embarrassing condition that is largely underreported. Obstetric anal sphincter injuries are the most important etiological factors. Anal sphincter injury during delivery is considered to be one of the major risk factors for fecal incontinence in women. After anal sphincter injury at the time of delivery, up to 50% women have complaints of fecal incontinence, mainly because of persisting sphincter defects. Objectives: To evaluate the risk factors for the occurrence of obstetric anal sphincter injuries during vaginal delivery. To evaluate the outcome of patients with obstetric anal sphincter injuries. Methodology: A retrospective descriptive study was conducted from 2014 to 2016. Data of all patients with Obstetric Anal Sphincter Injuries (OASIS) over 3 years was collected from the medical record section after ethical clearance from Institutional Review Committee (IRC), BPKIHS. The data was entered in the excel sheet and analyzed using SPSS 17. Results: The Most important risk factor of OASIS was operative vaginal delivery (vacuum assisted vaginal delivery), followed by birth weight of the baby greater than 3.5 Kg and primigravida. Conclusion: Patients undergoing operative vaginal delivery, primigravida and birth weight greater than 3 kg are the important risk factors for OASIS. So, patients with these conditions should be handled carefully during second stage of labor to prevent the occurrence of OASIS.

scholarly journals Evaluation of Suzor forceps training by studying obstetric anal sphincter injuries: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Perrine COSTE MAZEAU ◽  
Nedjma BOUKEFFA ◽  
Nathalie TICAUD BOILEAU ◽  
Samantha HUET ◽  
Maud TRAVERSE ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Retrospective Study ◽  
Observational Study ◽  
Anal Sphincter ◽  
University Hospital ◽  
Obstetric Anal Sphincter Injuries ◽  
Fourth Degree ◽  
Perineal Tears ◽  
Vacuum Extractor

Abstract Background Instrumental deliveries are an unavoidable part of obstetric practice. Dedicated training is needed for each instrument. To identify when a trainee resident can be entrusted with instrumental deliveries by Suzor forceps by studying obstetric anal sphincter injuries. Methods A French retrospective observational study of obstetric anal sphincter injuries due to Suzor forceps deliveries performed by trainee residents was conducted from November 2008 to November 2016 at Limoges University Hospital. Perineal lesion risk factors were studied. Sequential use of a vacuum extractor and then forceps was also analyzed. Results Twenty-one residents performed 1530 instrumental deliveries, which included 1164 (76.1%) using forceps and 89 (5.8%) with sequential use of a vacuum extractor and then forceps. Third and fourth degree perineal tears were diagnosed in 82 patients (6.5%). Residents caused fewer obstetric anal sphincter injuries after 23.82 (+/− 0.8) deliveries by forceps (p = 0.0041), or after 2.36 (+/− 0.7) semesters of obstetrical experience (p = 0.0007). No obese patient (body mass index> 30) presented obstetric anal sphincter injuries (p = 0.0013). There were significantly fewer obstetric anal sphincter injuries after performance of episiotomy (p <  0.0001), and more lesions in the case of the occipito-sacral position (p = 0.028). Analysis of sequential instrumentation did not find any additional associated risk. Conclusion Training in the use of Suzor forceps requires extended mentoring in order to reduce obstetric anal sphincter injuries. A stable level of competence was found after the execution of at least 24 forceps deliveries or after 3 semesters (18 months) of obstetrical experience.

scholarly journals Predictors of Severe Perineal Tear during Delivery in Yenagoa, Southern Nigeria

2021 ◽  
pp. 42-51
Author(s):  
Ikobho Ebenezer Howells ◽  
Isaac Joel Abasi
Keyword(s):  
Multivariate Analysis ◽  
Birth Weight ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Educational Level ◽  
Odds Ratio ◽  
Mode Of Delivery ◽  
Sphincter Injury ◽  
Perineal Tear ◽  
Anal Sphincter Injury

Background:Perineal tear is a very common complication of vaginal delivery, and it is often mild. However, when severe, it could result in torrential life threatening hemorrhage and anal sphincter injury, with fecal incontinence. Objective: The objective of this study is to determine the predictors of severe perineal tear (3rd and 4th degree tear), using mild perineal tear (1st and 2nd degree) as control. It would also determine the rate of perineal tear, and the maternal and fetal demographic risk factor associated with it. Materials and Methods: This was an analytic observational study of 186 women who had perineal tear during vaginal delivery. Out of these, 19 women had severe (3rd and 4th degree) perineal tear, also known as obstetrics anal sphincter injury (OASI). This was compared to 167 women who had mild perineal tear (1st and 2nd degree) during the study period. Maternal demographic information retrieved was maternal age, parity, educational level, and occupation. Obstetrics factors were booking status, gestational age at delivery, mode of delivery, rank of the accoucheur (nurse or doctor), and degree of perineal tear. Fetal demographic data was birth weight and fetal sex. Categorical variables were compared with odds ratio, difference in mean was compared with student’s t-test, and the degree of association for quantitative variables was determined using Pearson’s correlation coefficient. Predictor variables were determined using simple logistic regression, and multivariate analysis. Confidence interval was set at 95%, and statistical significance was set at p value of < 0.05. Results: The prevalence of OASI (3rd and 4th degree perineal tear) in Yenagoa was 1.1%. The significant risk factors were women of younger age, odds ratio = 1.04(0.37, 2.87) with p = 0.04, low parity, odds ratio = 0.20(0.07, 0.55) with p = 0.008, low educational background, odd ratio = 18.9(5.92, 60.81), and birth weight ≥ 4kg, odds ratio = 0.30[0.09, 1.06] with p = 0.04. Using simple liner regression, the most significant predictors for severe perineal tear were mode delivery (r2 = 65.5%), and educational level (r2 = 30.0%). However, on stepwise multivariate analysis, these two factors accounted for 68.5%. Conclusion: The rate of severe perineal tear is relatively low in Yenagoa, Nigeria, and comparable to what obtains in many countries. The most significant predictors were mode of delivery and educational level. Careful selection of the mode of delivery, especially instrumental vaginal deliveries, and women empowerment could minimize the rate in our environment.

Anal Sphincter Injury Associated with Vaginal Twin Delivery

2019 ◽  
Vol 37 (11) ◽  
pp. 1134-1139
Author(s):  
Bobby D. O'Leary ◽  
Tariq Bholah ◽  
Tamara Kalisse ◽  
Mark P. Hehir ◽  
Michael P. Geary
Keyword(s):  
Risk Factors ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Univariate Analysis ◽  
Mode Of Delivery ◽  
Significant Risk ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Vaginal Deliveries ◽  
Twin Pregnancies

Abstract Objective Obstetric anal sphincter injury remains the most common cause of fecal incontinence in women, and research in twin pregnancies is sparse. This study aimed to examine risk factors for sphincter injury in twin deliveries over a 10-year period. Study Design This was a retrospective study of twin vaginal deliveries in a tertiary-level hospital over 10 years. We examined the demographics of women who had a vaginal delivery of at least one twin. Logistic regression analysis was used to examine risk factors. Results There were 1,783 (2.1%) twin pregnancies, of which 556 (31%) had a vaginal delivery of at least one twin. Sphincter injury occurred in 1.1% (6/556) women with twins compared with 2.9% (1720/59,944) singleton vaginal deliveries. Women with sphincter injury had more instrumental deliveries (83.3 vs. 27.6%; p = 0.008). On univariate analysis, only instrumental delivery was a significant risk factor (odds ratio: 2.93; p = 0.019). Conclusion Sphincter injury occurs at a lower rate in vaginal twin pregnancies than in singletons. No twin-specific risk factors were identified. Discussion of the risk of sphincter injury should form part of patient counseling with regard to the mode of delivery.

Prolonged Second Stage of Labor and Anal Sphincter Injury in a Contemporary Cohort of Term Nulliparas

2020 ◽  
Author(s):  
Mariam Naqvi ◽  
Elana F. Jaffe ◽  
Ilona T. Goldfarb ◽  
Allison S. Bryant ◽  
Blair J. Wylie ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Sphincter Injury ◽  
Predictive Capacity ◽  
Fourth Degree ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Anal Sphincter Injury ◽  
Operative Vaginal Delivery ◽  
Multivariable Regression

Objective This study aimed to assess whether a prolonged second stage of labor is an independent predictor of obstetric anal sphincter injury (OASI) in a contemporary cohort of nulliparous and term parturients, and to evaluate whether predelivery factors can accurately predict OASI. Study Design This was a nested case-control study within a cohort of consecutive nulliparous term parturients with a singleton gestation who underwent a vaginal delivery at a single institution between January 2014 and January 2015. Cases were defined as women with a third- or fourth-degree laceration at the time of delivery, and controls were women without a third- or fourth-degree laceration. A prolonged second stage was defined as a second stage of ≥3 hours. Univariable and multivariable regression analyses were performed to examine the relationship between prolonged second stage of labor and third- or fourth-degree lacerations. Receiver operator curves were developed to assess the predictive capacity of predelivery information for third- and fourth-degree lacerations. Results Of 1,197 births, 63 women had third- or fourth-degree lacerations (5.3%). With each additional hour of the second stage, the rate of OASI increased, with 2.9% of women with a second stage of <1 hour with OASI, 3.5% between 1 and 2 hours, 5.7% between 2 and 3 hours, 7.8% between 3 and 4 hours, 16.1% between 4 and 5 hours, and 28.6% among women with a second stage length >5 hours (p < 0.001). In multivariable regression analysis, operative vaginal delivery (adjusted odds ratio [aOR] = 5.92, 95% confidence interval [CI]: 3.17–11.07) and a prolonged second stage (aOR = 1.92, 95% CI: 1.06–3.51) were independent predictors of third- and fourth-degree lacerations. A predictive model was developed from these results (area under the curve [AUC] = 0.75, 95% CI: 0.68–0.81). Conclusion Prolonged second stage of labor is a predictor of OASI, after adjustment for operative vaginal delivery. A model using predelivery risk factors has a reasonable prediction of OASI. Key Points

scholarly journals The Incidence of Anal Sphincter Ruptures and Risk Factors

2016 ◽  
pp. 31-36
Author(s):  
Budi I Santoso ◽  
Denny Khusen
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Gestational Age ◽  
Univariate Analysis ◽  
Forceps Delivery ◽  
Fourth Degree ◽  
Control Subjects ◽  
Vaginal Deliveries

Objective: To analyze the incidence of anal sphincter ruptures and to evaluate risk factors of obstetric anal sphincter ruptures in Dr. Cipto Mangunkusumo Hospital. Method: We reviewed 2009 vaginal deliveries based on the analysis of obstetric data base and patient records of our department during 2012. Cases and control subjects were chosen randomly and patient’s records were reviewed for the following variable: maternal age, parity, gestational age, labor induction, duration of 2nd stage labor, use of forceps, use of vacuum, use of episiotomy, birth weight, and presentation of the baby. Result: There were 91 (4.53%) anal sphincter ruptures during period of study (91 of 2009 patients). An univariate analysis of these 91 case and 91 randomly selected control subjects show that primiparity (p = .000), gestational age (p = .016), duration of second-stage labor (p = .000), forceps delivery (p = .000), vacuum delivery (p = .001), episiotomy (p = .000), and birth weight (p = .000) increased the risk for anal sphincter ruptures. In multivariate re-gression models, only 5 of the 10 predictor variables were significantly related to the likelihood of having a severe perineal trauma greater than second degree. Primiparity (p = .023; OR 2.74, 95% [CI], 1.15-6.51), forceps delivery (p = .000; OR 18.18, 95% [CI] 3.84-86.07), vacuum delivery (p = .005; OR 6.83, 95% [CI] 1.77-26.42), episiotomy (p = .015; OR 2.86, 95% [CI] 1.23-6.65), and birth weight (p = .000; OR 0.99, 95% [CI] 0.997-0.999). Conclusion: Damage of the anal sphincter resulting in a third- or fourth- degree perineal tear is a relatively rare but severe complication of vaginal delivery. We found that factors as sociated with anal sphincter ruptures were primiparity, forceps, vacuum, episiotomy and birth weight. [Indones J Obstet Gynecol 2016; 1: 31-36] Keywords: anal sphincter ruptures, third- or fourth- degree perineal tear, vaginal delivery

scholarly journals Prevalence of high-grade perineal tear during labor in Mexican adolescents

2018 ◽  
pp. 261-264
Author(s):  
María Teresa Sánchez-Ávila ◽  
Marisol Galván-Caudillo ◽  
Jaime Javier Cantú-Pompa ◽  
Natalia Vázquez-Romero ◽  
Jhanea Patricia Martínez-López ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstetric Care ◽  
Tertiary Hospital ◽  
High Rate ◽  
Adult Women ◽  
High Grade ◽  
Hospital Data ◽  
Perineal Tear ◽  
Fourth Degree ◽  
Perineal Tears

Introduction: There is a high rate of deliveries in adolescents in Mexico. This age group is vulnerable to obstetric complications, including lacerations of the anal sphincter. Objective: To determine the prevalence of third and fourth degree perineal tears in adolescents during childbirth, and to evaluate risk factors in comparison with deliveries with lacerations of adult women. Methods: All obstetric care episodes were reviewed from a public tertiary hospital data in Monterrey, Mexico in 2014. Age, primiparity, delivery instrumentation, episiotomy, body mass index, product weight and tear´s degree were documented at the deliveries with tears of third and fourth degree. Results: The prevalence of third and fourth degree tears of 2.0% was found in the general population, being adolescents the most affected with 2.5%. The unadjusted odds ratio of high-grade tears in adolescent females at delivery, compared to adult females, was 1.36 (95% CI = 0.99-1.86, p= 0.05). No difference was found when comparing risk factors among high-grade tear deliveries in adolescents versus adults. Conclusions: A higher prevalence than previous reported for high grade tears during delivery was found. The data suggest adolescence as a risk factor for high-grade tears during delivery.

scholarly journals Obstetric anal sphincter injury in adolescent mothers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henry H. Chill ◽  
Michal Lipschuetz ◽  
Eyal Atias ◽  
Tzvika Shimonovitz ◽  
David Shveiky ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Adolescent Mothers ◽  
Head Circumference ◽  
Obstetric Anal Sphincter Injury ◽  
Age Group ◽  
Adult Group ◽  
Sphincter Injury ◽  
Anal Sphincter Injury

Abstract Background Obstetric anal sphincter injury (OASI) is a debilitating complication of vaginal delivery which has yet to receive ample attention in adolescents. The aim of this study was to describe risk for OASI in adolescent mothers compared to adults. We further attempted to compare risk factors for OASI between these two age groups. Methods We performed a retrospective cohort study between 2003 and 2019. Primiparous women who delivered vaginally, 21 years and younger were compared to women ages 26–35. Excluded were preterm, multifetal, non-vertex, cesarean deliveries as well as intrauterine fetal death. Rate of OASI as well as obstetric and labor characteristics of women with OASI, were compared between groups. Finally, risk factors were assessed for each group separately. Univariate and multivariate logistic regression model were performed. Results Final analysis was performed on 5113 nulliparous adolescents and 13,845 nulliparous in the 26–35 age group. Allocation to study groups was according to OASI – Sixty-seven adolescents (1.3%) had a 3rd or 4th degree perineal tear and were defined as the OASI group, while 5046 patients (98.7%) did not have such a tear. In the adult group, 199 out of 13,845 patients (1.4%) were diagnosed with OASI. Occurrence of OASI did not differ between groups (p = 0.510). Comparison of women with OASI in the adolescent group vs. adult group found differences with regard to operative vaginal delivery, (20.9% vs. 36.2%, respectively; p = 0.023) and meconium stained amniotic fluid (9.1% vs. 21.3%, respectively; p = 0.027). Following multivariate analysis the only parameter independently associated with OASI in the adolescent age group was head circumference ≥ 90th percentile with an adjusted odds ratio of 3.08 (CI 1.48–6.38, p = 0.003). In the adult group the similar analysis revealed operative vaginal delivery (OR = 2.44, CI 1.72–3.47, p < 0.001) and a birthweight≥90th percentile (OR = 2.23, CI 1.19–4.18, p = 0.012) to be independent risk factors for OASI. Conclusion Adolescents have similar risk for OASI compared to adults but differ in risk factors leading to OASI. Head circumference ≥ 90th percentile was found to be associated with OASI in this age group.

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