Counseling After Obstetric Anal Sphincter Injury: How do Health Care Providers Perform?

Obstetric anal sphincter injuries are associated with significant morbidity and increased recurrence risk in subsequent deliveries. In subsequent pregnancies, it is important to provide appropriate counseling and mode of delivery planning.

The primary objective of this study was to determine the rate of obstetric anal sphincter injury counseling that patients with prior injury receive in their subsequent pregnancy. Secondary objectives include assessing the counseling quality, effect of counseling on delivery decisions, and counseling rates by patient risk factors.

This was a descriptive cohort study through electronic medical record review at 2 academic institutions. Participants were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes and delivery summary documentation.

A total of 218 patients met eligibility criteria, and of these, 39% received counseling on obstetric anal sphincter injury history in their first subsequent pregnancy. Patients with fourth-degree lacerations or at least 1 sequela, notably anal incontinence or psychological trauma, were the most likely to receive counseling. The cesarean delivery rate was significantly higher in the counseled group (25% vs 5%), and 62% of cesarean deliveries in the counseled group were performed for obstetric anal sphincter injury history.

There was a low rate of obstetric anal sphincter injury counseling performed in the subsequent pregnancy. Further research is needed to understand the reason for low counseling rates and the role counseling plays in shaping delivery planning decisions.