Mode of delivery after previous obstetric anal sphincter injuries (OASIS)--a reappraisal?
OBJECTIVE
To prospectively evaluate anorectal symptoms, quality of life (QoL), sphincter integrity and function after subsequent childbirth following previous obstetric anal sphincter injuries (OASIS).


METHODS
A validated Manchester Health Questionnaire, endoanal sonography and manometry were performed during the third trimester and 13 weeks postpartum. Women without objective compromise of anal function were recommended a vaginal delivery and the others a caesarean section.


RESULTS
Seventy-three consecutive women with previous OASIS were seen during a subsequent pregnancy of whom 59 were reviewed 13 weeks following delivery. Anal manometry findings did not change significantly following a subsequent vaginal delivery or caesarean section. Only one new defect (internal sphincter) occurred after a vaginal delivery. There was no significant change in symptoms or QoL. Three (6.8%) sustained repeat OASIS.


CONCLUSIONS
Women who have no antenatal evidence of objective compromise of anal sphincter function can be reassured that a vaginal delivery is not associated with any significant deterioration in function or QoL.
Scheer
Inka
I
Urogynaecology, Mayday University Hospital, 530 London Road, Croydon CR7 7YE, UK.
Thakar
Ranee
R
Sultan
Abdul H
AH
D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000293:injuries*; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D010358:Patient Participation; D011247:Pregnancy; D011446:Prospective Studies; D011788:Quality of Life; D014463:Ultrasonography