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Obstetric Anal Sphincter Injuries at Vaginal Delivery: A Review of Recently Published National Guidelines
Ioannis Tsakiridis1, Apostolos Mamopoulos2, Apostolos Athanasiadis3
1Resident Assistant.
Insights
Obstetric anal sphincter injuries (OASISs) affect 1 in 10 deliveries. National guidelines suggest warm perineal compresses and massage for prevention, and careful repair with antibiotics for management to reduce OASIS-related complications.
Area of Science:
- Obstetrics and Gynecology
- Surgical Outcomes
- Evidence-Based Medicine
Background:
- Obstetric anal sphincter injuries (OASISs) are a significant complication, affecting approximately 10% of vaginal deliveries.
- Standardized guidelines are crucial for consistent prevention and management of OASISs.
Purpose of the Study:
- To review and compare national guidelines on the prevention and management of OASISs during vaginal delivery.
- To identify common recommendations and variations in current obstetric care standards.
Main Methods:
- A descriptive review of three key national guidelines: RCOG, ACOG, and SOGC.
- Comparison of guideline recommendations for OASIS prevention and management.
- Assessment of the quality of evidence reported within each guideline.
Main Results:
- National guidelines differ on OASIS prevention and management strategies.
- Routine episiotomy is not recommended; warm perineal compresses and massage show protective effects.
- OASIS management requires meticulous repair of sphincters and anorectal mucosa, with recommended postoperative antibiotics, laxatives, and analgesia.
Conclusions:
- Harmonized guidelines can improve the specialized care for OASIS prevention and management.
- Implementing consistent practices may lead to a reduction in OASIS-related maternal morbidity.
Importance:
Obstetric anal sphincter injuries (OASISs) complicate approximately 1 in 10 deliveries.
Objective:
The aims of this study were to review and compare recommendations from recently published national guidelines regarding OASISs at vaginal delivery.
Evidence Acquisition:
Three national guidelines on OASISs at vaginal delivery are presented through a descriptive review: Royal College of Obstetricians and Gynaecologists on "The Management of Third- and Fourth-Degree Perineal Tears," American College of Obstetricians and Gynecologists on "Prevention and Management of Obstetric Lacerations at Vaginal Delivery," and Society of Obstetricians and Gynaecologists of Canada on "Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair." These guidelines were summarized and compared in terms of prevention and management of OASISs. Quality of evidence was also reviewed based on method of reporting for each guideline.
Results:
This published evidence reflects the differences between the national recommendations on the prevention and management of OASISs. Especially, as for the prevention of OASIS, routine use of episiotomy is not recommended, whereas warm perineal compresses and perineal massage during the second stage of labor seem to have a protective role. In the management of OASIS, special care is needed during the repair process of the torn anorectal mucosa and the internal and external anal sphincter. The postoperative use of broad-spectrum antibiotics, oral laxatives, and analgesia is also recommended.
Conclusions:
Summarized guidelines can have an impact on special care in prevention and management of OASIS; this may support the reduction of morbidity associated with that entity.
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