Factors Affecting Follow-up for Specialty Postpartum Care after Obstetric Anal Sphincter Injury at a Single U.S....

Early postpartum specialist care may improve outcomes for birthing people who sustain obstetric anal sphincter injuries (OASIS). This study was aimed at describing follow-up rates in a postpartum recovery clinic (PPRC) for patients who sustained OASIS at delivery, and at identifying factors associated with failure to follow up. We hypothesized that providing care in PPRC would result in high rates of access to specialized care for OASIS.

This was a retrospective cohort study of patients with OASIS at a single institution from January 2018 to December 2023. Patients who sustain OASIS receive an automatic referral to PPRC within 3 weeks postpartum. Demographic and follow-up data were extracted from the medical records, including Edinburgh Postpartum Depression Scale (EPDS) score. The primary outcome was follow-up in PPRC. We examined associations between patient characteristics and failure to follow up using univariable and multivariable logistic regression.

Among 659 deliveries with OASIS during the study period, 540 (81.9%) followed up in a PPRC and of those 468 (86.7%) followed up within 3 weeks. Failure to follow up was associated with multiparity, Black race, Hispanic ethnicity, having Medicaid or state insurance, and elevated EPDS score on univariable analysis. On multivariable analysis, having Medicaid or state medical assistance and elevated depression screening remained associated with failure to follow up in a PPRC.

There was a high overall attendance rate at a urogynecologist-led postpartum clinic in birthing people who sustained OASIS. An elevated depression screening score and having Medicaid or state medical assistance were associated with failure to follow up.