Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study
| Autor: | Stephanie Grigsby, Abdul H. Sultan, Clare F. Jordan, Ash Monga, Douglas G Tincello, Joanna C. D’Souza, Ranee Thakar, Christopher Ashmore, Ayisha Kibria, Timothy Hillard |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Episiotomy
medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology Anal Canal Logistic regression 03 medical and health sciences 0302 clinical medicine Pregnancy Risk Factors medicine Humans Multi centre Mediolateral episiotomy Perineal trauma Retrospective Studies 030219 obstetrics & reproductive medicine Cesarean Section Obstetrics business.industry Vaginal delivery Obstetric anal sphincter injuries Obstetrics and Gynecology Retrospective cohort study Delivery Obstetric Obstetric Labor Complications Increased risk Recurrent obstetric anal sphincter injury Original Article Female business Anal sphincter |
| Zdroj: | International Urogynecology Journal |
| ISSN: | 1433-3023 |
| Popis: | Introduction and hypothesis: Women with a history of obstetric anal sphincter injury (OASI) are at increased risk of recurrence (rOASI) at subsequent delivery; however, evidence regarding the factors influencing this risk is limited. Furthermore, little is known about what factors influence the decision to alternatively deliver by elective caesarean section (ELLSCS). Methods: Retrospective univariate and multivariate logistic regression analysis of prospectively collected data from four NHS electronic maternity databases including primiparous women sustaining OASIS during a singleton, term, cephalic, vaginal delivery between 2004 and 2015, who had a subsequent delivery. Results: Two thousand two hundred seventy-two women met the criteria; 10.2% delivering vaginally had a repeat OASI and 59.4% had a second-degree tear. Women having an ELLSCS were more likely to be Caucasian, older, have previously had an operative vaginal delivery (OVD) and have a more severe degree of OASI. Positive predictors for rOASI were increased birth weight and maternal age at both index and subsequent deliveries, a more severe degree of initial OASI and Asian ethnicity. The overall mediolateral episiotomy (MLE) rate was 15.6%; 77.2% of those who had an episiotomy sustained no spontaneous perineal trauma. Only 4.4% of women with a rOASI had an MLE, whilst the MLE rate was 16.9% in those without a recurrence (p < 0.001). MLE decreased the risk of rOASI by 80%. Birth weight > 4 kg increased the risk 2.5 fold. Conclusions: Women with previous OASIS are at an increased risk of recurrence. A more liberal use of MLE during subsequent vaginal delivery could significantly reduce the risk of recurrence. |
| Databáze: | OpenAIRE |
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