Obstetrical anal sphincter injury: counseling for future deliveries

This article provides a comprehensive review of counseling in subsequent deliveries for patients with a history of obstetrical anal sphincter injury. Patients with prior obstetrical anal sphincter injury are at increased risk for recurrent obstetrical anal sphincter injury compared with other multiparous patients. However, the rates of primary and recurrent obstetrical anal sphincter injury are similar at 4.4% to 11% and 3.7% to 13.4%, respectively. Subsequent delivery care includes a review of the index delivery course, acute postpartum complications, obstetrical anal sphincter injury sequelae, and patient risk factors. Counseling should include understanding the patient's values and preferences, a risk-benefit discussion of delivery modalities, and an appropriate recommendation for the subsequent mode of delivery. There are no absolute contraindications to subsequent vaginal delivery, and newer data suggest that appropriate mode of delivery selection results in stable pelvic floor functional status. This highlights the importance of counseling for shared decision-making in future delivery planning.