Mode of delivery following an OASIS and caesarean section rates
| Autor: | Ilias Giarenis, Sambit Mukhopadhyay, Charlotte Cassis, Edward Morris |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Manometry External anal sphincter medicine.medical_treatment Anal Canal Asymptomatic Ultrasonography Prenatal Internal anal sphincter 03 medical and health sciences 0302 clinical medicine Pregnancy Endoanal ultrasound medicine Humans Caesarean section 030212 general & internal medicine Retrospective Studies 030219 obstetrics & reproductive medicine Cesarean Section Obstetrics business.industry Anorectal manometry Obstetrics and Gynecology Delivery Obstetric Obstetric Labor Complications medicine.anatomical_structure Reproductive Medicine Cohort Sphincter Female medicine.symptom business Algorithms Fecal Incontinence |
| Zdroj: | European Journal of Obstetrics & Gynecology and Reproductive Biology. 230:28-31 |
| ISSN: | 0301-2115 |
| DOI: | 10.1016/j.ejogrb.2018.09.020 |
| Popis: | Objectives While the rate of obstetric anal sphincter injury (OASIS) is increasing, there is a lack of evidence on how best to advise women on mode of delivery (MOD) afterwards. The objectives of this study were to assess the clinical value of bowel symptoms, endoanal ultrasound and anorectal manometry in the management of pregnancies after an OASIS and evaluate the performance of different algorithms. Study Design This was a retrospective analysis of prospectively collected data in a university hospital perineal clinic. Women with OASIS undergoing endoanal ultrasound scan (EAUS) and anorectal manometry (AM) were included in this study (all women with an OASIS, except the asymptomatic 3a tears). A number of published algorithms were theoretically applied in this cohort to define recommended MOD after an OASIS. Results Out of the 233 women included in the study, 51 (21.9%) were symptomatic, 141 (60.5%) had persistent sphincter defects on EAUS and 124 (53.2%) had abnormal AM. One asymptomatic and five symptomatic women were found to have isolated internal anal sphincter (IAS) defects without external anal sphincter (EAS) defects. There were no women with low resting pressure and normal incremental squeeze pressure. The application of the algorithm requiring only one abnormal investigation to be recommended caesarean would have led to an 81.5% caesarean rate. If women with symptoms of anal incontinence or abnormal investigations would be advised for caesarean the rate would be 85.0%. Using the local protocol where symptomatic women only needed one of the two investigations to be abnormal but asymptomatic women were required to have both investigations being abnormal, 94 were considered for caesarean (40.3%). Conclusion There is a wide range in the number of patients recommended to have caesarean section after an OASIS, depending on the used criteria and management algorithms. There is minimal additional information gained from identifying internal anal sphincter defects and measuring low resting pressures at manometry. |
| Databáze: | OpenAIRE |
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