Factors that influence patient preference for mode of delivery following an obstetric anal sphincter injury

A common indication for elective caesarean is previous obstetric anal sphincter injury (OASI). This study aims to identify factors that influence womens' preferences regarding mode of delivery (MoD) in a subsequent pregnancy following an OASI.

100 consecutive women who sustained an OASI completed a questionnaire when attending postnatal follow up at a perineal trauma clinic. They also completed ePAQ-PF to assess pelvic floor symptoms. Data was collated and percentages generated for each response. A chi-squared calculation was used for preferred MoD.

In total, 75 women were Primiparous and 25 Multiparous. 20% of women were advised to have a caesarean, with the remainder advised either a vaginal delivery or further investigations. 79% of women had a 3a/3b tear and 21% of women had a 3c/4th degree OASI. Based on women's preferences, those who sustained a 3c/4th degree tear were more likely to opt for CS than a 3a/b degree tear (p<0.001). Bowel symptoms per se did not correlate with choice of MoD in either group. In women with 3c/4th OASI vaginal or sexual symptoms did not impact on the decision regarding choice of delivery but in women who sustained a 3a/b tear the impact on sexual function appears to be the commonest symptom in those who wished a caesarean section.

Women with 3c/4th OASI are more likely to accept a planned CS. Bowel symptoms appear to have little impact on this but in women with lower grade tears sexual symptoms have the greatest impact on preferred MoD.