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Defining an at-risk population for obstetric anal sphincter laceration
Steven M Minaglia1, Chieko Kimata, Karen A Soules
1Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
American Journal of Obstetrics and Gynecology
|September 19, 2009
Summary
Five cesarean deliveries are necessary to prevent one case of obstetric anal sphincter laceration in women with obstructed labor undergoing operative vaginal delivery. This finding highlights the risks associated with operative vaginal delivery.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Surgical Outcomes
Background:
- Operative vaginal delivery is associated with a risk of obstetric anal sphincter lacerations (OASIS).
- Obstructed labor presents complex management decisions between operative vaginal delivery and cesarean delivery.
- Understanding the comparative risks is crucial for informed clinical practice.
Purpose of the Study:
- To determine the number of cesarean deliveries required to prevent one case of OASIS.
- To quantify the risk of OASIS in a cohort of women with obstructed labor.
Main Methods:
- Retrospective analysis of a computerized institutional database.
- Inclusion of women with obstructed labor (cephalopelvic disproportion, arrest of descent, maternal exhaustion, fetal distress).
- Comparison of OASIS rates between operative vaginal delivery and cesarean delivery groups.
Main Results:
- 23.9% of women (50/209) undergoing operative vaginal delivery sustained an OASIS.
- No OASIS occurred in the 254 women who underwent cesarean delivery.
- The number needed to treat (NNT) for cesarean delivery to prevent one OASIS was 4.2.
Conclusions:
- Five cesarean deliveries are needed to prevent one OASIS in this at-risk cohort.
- Cesarean delivery is a safer alternative to operative vaginal delivery for preventing OASIS in obstructed labor.
- This data supports a conservative approach to operative vaginal delivery in complex cases.
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