OASI Wound Complications and Impact on Future Delivery Outcomes

Perineal wound complications following an obstetric anal sphincter injury (OASI) repair may affect pelvic floor recovery, continence, and sexual functioning, yet are understudied. Understanding risk factors for recurrent complications after OASI may aid in future delivery planning.

This study aimed to identify characteristics associated with wound complications and compare rates of recurrent OASI and perineal wound complications after subsequent vaginal delivery in patients with and without prior wound complications.

This retrospective cohort study of patients seen in a urogynecologist-led postpartum recovery clinic after OASI during an index delivery between January 1, 2018, and December 31, 2023, with a subsequent delivery in the same health system. Wound complication was defined as infection requiring antibiotics, wound dehiscence, granulation tissue requiring treatment, or surgical revision. Demographic, obstetric characteristics, and subsequent vaginal delivery outcomes were compared between patients with and without wound complications after index delivery. T tests and χ2 tests were used for statistical analysis.

Among 163 patients with an initial OASI, 41.7% experienced wound complications. No demographic or obstetric variables were associated with wound complications. In the subcohort of 91 patients with a subsequent vaginal delivery, recurrent OASIs occurred in 5 (5.5%) and was not associated with prior wound complications (P=0.44). Only 1 patient (1.1%) experienced a wound complication within 30 days of subsequent delivery, with no significant difference by prior wound complication status.

In this cohort of patients with OASIs managed through a postpartum recovery clinic, recurrent OASI and wound complications in subsequent deliveries were uncommon. These findings may aid in counseling regarding delivery planning after OASIS.