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Mode of Subsequent Delivery After Obstetric Anal Sphincter Injuries (OASIs).

May Alarab1, Swati Jha2, Fernanda Pipitone3,4

  • 1Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada. May.Alarab@sinaihealth.ca.

International Urogynecology Journal
|June 2, 2026
PubMed
Summary

Women who experience obstetric anal sphincter injuries (OASIs) need expert guidance for delivery mode in future pregnancies. Comprehensive assessment and collaborative decision-making are key for optimal outcomes and reduced regret.

Keywords:
Fecal incontinenceObstetric anal sphincter injury (OASI)Perineal traumaRecurrence of OASISubsequent delivery

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Area of Science:

  • Urogynecology
  • Obstetrics
  • Maternal Health

Background:

  • Obstetric anal sphincter injuries (OASIs) are severe perineal lacerations impacting quality of life.
  • OASIs rates are rising globally due to increased awareness and reporting.
  • Women with prior OASIs face delivery mode dilemmas in subsequent pregnancies.

Purpose of the Study:

  • To provide guidance on the assessment and management of women with previous OASIs.
  • To summarize evidence-based recommendations for the mode of subsequent delivery post-OASIs.
  • To inform clinical practice and counselling for women facing delivery decisions after OASIs.

Main Methods:

  • A narrative review combined with expert opinion from the International Urogynaecological Association (IUGA) I, R&D Committee.
  • Literature review focused on recommended mode of subsequent delivery for women with previous OASIs.
  • Evaluation of the impact of delivery mode on pelvic floor function, quality of life, and maternal regret.

Main Results:

  • Guidance is provided for assessing and managing women affected by OASIs.
  • Evidence-based recommendations for subsequent delivery mode are summarized.
  • The review highlights the importance of considering pelvic floor function and quality of life.

Conclusions:

  • Postpartum fecal incontinence is multifactorial, requiring comprehensive assessment.
  • Expert clinical assessment and collaborative decision-making are recommended for subsequent delivery mode.
  • Informed decisions regarding delivery post-OASIs should involve the woman and her healthcare provider.