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Can the risk of obstetric anal sphincter injuries (OASIs) be predicted using a risk-scoring system?

Karl C McPherson, Andrew D Beggs, Abdul H Sultan1

  • 1Department of Obstetrics & Gynaecology, Croydon University Hospital, 530 London Road, Croydon, CR7 7YE London, UK. abdul.sultan@croydonhealthservices.nhs.uk.

BMC Research Notes
|July 25, 2014
PubMed

Insights

A new risk scoring model can help predict anal sphincter injuries during vaginal delivery. This tool identifies factors like ethnicity and smoking to improve prevention strategies for Obstetric Anal Sphincter Injuries (OASIs).

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Epidemiology

Background:

  • Perineal trauma, specifically anal sphincter injuries, is a significant complication of vaginal childbirth.
  • Accurate prediction of these injuries can enhance preventative measures.
  • Obstetric Anal Sphincter Injuries (OASIs) require improved risk assessment tools.

Purpose of the Study:

  • To develop and validate a predictive risk scoring model for Obstetric Anal Sphincter Injuries (OASIs).
  • To identify novel and confirm known risk factors associated with OASIs.
  • To provide a tool for better prediction and prevention of anal sphincter trauma during vaginal delivery.

Main Methods:

  • Analysis of 16,920 vaginal deliveries from 2004-2008 using electronic maternity records.
  • Logistic regression analysis to identify significant risk factors (p < 0.05).
  • Construction of a risk scoring algorithm based on odds ratios, tested on a separate patient cohort.

Main Results:

  • OASIs occurred in 3.6% of deliveries.
  • Risk factors increasing OASIs included African-Caribbean descent, water immersion/birth, and instrumental delivery (ventouse, forceps).
  • Protective factors included South Asian descent, multiparity, current smoking, and home delivery. The model achieved 52.7% sensitivity and 71.1% specificity.

Conclusions:

  • Confirmed known risk factors (parity, birth weight, instrumentation) and identified new ones (smoking, ethnicity, water immersion).
  • The developed risk scoring system demonstrates reasonable predictive capability for OASIs.
  • This model offers a potential improvement over current screening practices, necessitating further studies on clinical impact for third-degree tear prevention.
Abstract

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