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.
Introduction And Hypothesis:
Obstetric anal sphincter injuries (OASIs) are severe perineal lacerations, which have a significant impact on quality of life. The rate of OASIs has been increasing worldwide due to improved awareness, recognition, and reporting. When these women conceive again, they are faced with a dilemma regarding the most appropriate mode of delivery. Although counselling about mode of delivery guides women's decisions, there is a large variation in clinical practice and advice provided to women worldwide. To date, limited literature is available to guide counselling for an optimal mode of delivery of subsequent pregnancy post-OASIs.
Materials And Methods:
A working subcommittee from the International Urogynaecological Association (IUGA) Innovation, Research, and Development (I, R&D) Committee was created. A literature review was performed to produce a draft, which focused on the recommended mode of subsequent delivery for women with previous OASIs. This document was then evaluated by the entire IUGA I, R&D Committee and revisions were implemented. This review examined the impact of subsequent mode of delivery on pelvic floor functions, overall quality of life, and women's regret regarding their chosen delivery mode. This work represents a narrative review combined with expert opinion, rather than a systematic review or formal guideline.
Results:
In this opinion paper, the R&D Committee provides guidance regarding the assessment and management of women affected by OASIs and summarises the evidence-based recommendations for the mode of subsequent delivery based on the currently available literature.
Conclusion:
Postpartum faecal incontinence is multifactorial. A comprehensive assessment by an expert clinician using available resources is recommended to guide an informed decision using a collaborative approach regarding the preferred mode of subsequent delivery post OASIs.
Related Concept Videos
Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Aneurysm III: Interprofessional Care
Ostomy Care
An ostomy is a surgical procedure that creates an artificial opening from the intestines to the outside of the body, allowing for the rerouting of effluent. This opening is known as a stoma. A stoma usually protrudes above the skin surface, appearing pink or red, moist, and round, and it lacks nerve sensations.
There are different types of ostomies, including colostomies, ileostomies, and urostomies:
Aneurysm IV: Nursing Management
Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...

