Obstetric anal sphincter injury and incontinence 15-23 years after vaginal delivery

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Tuva K Halle1,2, Kjell Å Salvesen3,4, Ingrid Volløyhaug2,3

  • 1Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

Acta Obstetricia Et Gynecologica Scandinavica
|March 19, 2016
PubMed

Insights

Operative vaginal deliveries (OVD) significantly increase the risk of obstetric anal sphincter injuries (OASIS) compared to normal vaginal deliveries (NVD). OASIS is linked to long-term anal incontinence and distress.

Area of Science:

  • Obstetrics and Gynecology
  • Pelvic Floor Disorders
  • Maternal Health

Background:

  • Obstetric anal sphincter injuries (OASIS) are a significant concern following childbirth.
  • Understanding the prevalence and long-term consequences of OASIS is crucial for improving maternal care.

Purpose of the Study:

  • To determine the prevalence of OASIS in normal vaginal deliveries (NVD) versus operative vaginal deliveries (OVD).
  • To compare OASIS rates between forceps (FD) and vacuum (VD) deliveries.
  • To investigate the long-term association between OASIS and anal incontinence.

Main Methods:

  • Cross-sectional study of 8137 primiparous women (Trondheim, Norway, 1990-1997).
  • Analysis of OASIS prevalence by delivery type (NVD, OVD, FD, VD).
  • Long-term follow-up using postal questionnaires (CRADI) for anal incontinence assessment in 1122 women.

Main Results:

  • OASIS prevalence was 2% for NVD and 10% for OVD (FD 10%, VD 9%).
  • OVD showed a 5-fold increased risk of OASIS compared to NVD (aOR 5.01).
  • OASIS was associated with increased risk of anal incontinence and higher Colorectal-Anal Distress Inventory (CRADI) scores years later.

Conclusions:

  • Operative vaginal delivery is a significant risk factor for OASIS.
  • Forceps delivery, compared to vacuum, showed a higher risk of fourth-degree perineal tears.
  • OASIS is linked to long-term anal incontinence and reduced quality of life.
Abstract

Keywords:
Obstetric anal sphincter injuryanal incontinencefecal incontinenceobstetricalobstetrical forcepsperineum/injuriesvacuum extraction

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