Management of obstetric anal sphincter injuries at the University Hospital of the West Indies.
Up to 6% of women sustain severe perineal lacerations that involve the anal sphincters during vaginal delivery. When they occur obstetric anal sphincter injuries (OASI) may be accompanied by significant morbidity. Therefore, it is important to detect these injuries promptly and for experienced staff to perform sound repair. This report retrospectively assesses a series of seven women with OASI who were managed at a tertiary level hospital in Jamaica over a period of 28 months. Unfavourable details of management that may have adversely affected outcomes were sought from the various cases treated The incidence of OASI was low (0.2%). There were five third degree and two fourth degree lacerations. After these injuries were repaired, three patients (43%) experienced morbidity such as chronic pelvic pain (43%), anal incontinence (29%), dyspareunia (23%) and recto-vaginal fistulae (14%). In order to improve the outcomes at this institution, several aspects of current care can be improved. Operative repair of these injuries should be delayed until senior staff is available to supervise OASI repair. Both methods of sphincter repair are reasonable options but the use of rapidly absorbable sutures is not appropriate. Finally, prophylaxis against wound infections can be achieved by administering a single dose of intravenous second or third generation cephalosporin at the time of induction of anaesthesia.
Cawich
S O
SO
Department of Basic Medical Sciences, Section of Anatomy, The University of the West Indies, Kingston 7, Jamaica, West Indies. socawich@hotmail.com
Mitchell
D I G
DI
Martin
A
A
Brown
H
H
DaCosta
V E
VE
Lewis
T
T
Newnham
M
M
Christie
L
L
D000328:Adult; D001003:Anal Canal / Q000293:injuries* / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D014900:West Indies / Q000453:epidemiology; D014947:Wounds and Injuries / Q000209:etiology / Q000473:pathology* / Q000601:surgery
D000900:Anti-Bacterial Agents