title: Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair.
abstract: OBJECTIVE
  To review the evidence relating to obstetrical anal sphincter injuries (OASIS) with respect to diagnosis, repair techniques and outcomes. To formulate recommendations as to patient counselling regarding route of delivery for subsequent pregnancy after OASIS.
  
  
  METHODS
  Obstetrical care providers caring for women with OASIS have the option of repairing the anal sphincter using end-to-end or overlapping techniques. They may also be involved in counselling women with prior OASIS regarding the route of delivery for future pregnancies.
  
  
  RESULTS
  The outcome measured is anal continence following primary OASIS repair and after subsequent childbirth.
  
  
  METHODS
  Published literature was retrieved through searches of Medline, EMBASE, and The Cochrane Library in May 2011 using appropriate controlled vocabulary (e.g., anal canal, obstetrics, obstetric labour complication, pregnancy complication, treatment outcome, surgery, quality of life) and key words (obstetrical anal sphincter injur*, anus sphincter, anus injury, delivery, obstetrical care, surgery, suturing method, overlap, end-to-end, feces incontinence). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.
  
  
  METHODS
  The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1).
  
  
  RESULTS
  Benefits from implementation of these guidelines include: improved diagnosis of OASIS, optimal functional outcomes following repair, and evidence-based counselling of women for future childbirth.
authors.affiliation: Kingston ON.
authors.forename: Marie-Andrée
authors.initials: MA
authors.lastname: Harvey
authors.affiliation: Halifax NS.
authors.forename: Marianne
authors.initials: M
authors.lastname: Pierce
authors.affiliation: Montreal QC.
authors.forename: Jens-Erik W
authors.initials: JE
authors.lastname: Alter
authors.affiliation: London ON.
authors.forename: Queena
authors.initials: Q
authors.lastname: Chou
authors.affiliation: Toronto ON.
authors.forename: Phaedra
authors.initials: P
authors.lastname: Diamond
authors.affiliation: Saskatoon SK.
authors.forename: Annette
authors.initials: A
authors.lastname: Epp
authors.affiliation: Vancouver BC.
authors.forename: Roxana
authors.initials: R
authors.lastname: Geoffrion
authors.affiliation: Kingston ON.
authors.forename: Marie-Andrée
authors.initials: MA
authors.lastname: Harvey
authors.affiliation: Montreal QC.
authors.forename: Annick
authors.initials: A
authors.lastname: Larochelle
authors.affiliation: Winnipeg MB.
authors.forename: Kenny
authors.initials: K
authors.lastname: Maslow
authors.affiliation: Calgary AB.
authors.forename: Grace
authors.initials: G
authors.lastname: Neustaedter
authors.affiliation: Ottawa ON.
authors.forename: Dante
authors.initials: D
authors.lastname: Pascali
authors.affiliation: Halifax NS.
authors.forename: Marianne
authors.initials: M
authors.lastname: Pierce
authors.affiliation: Edmonton AB.
authors.forename: Jane
authors.initials: J
authors.lastname: Schulz
authors.affiliation: Vancouver BC.
authors.forename: David
authors.initials: D
authors.lastname: Wilkie
authors.forename: Abdul
authors.initials: A
authors.lastname: Sultan
authors.forename: Ranee
authors.initials: R
authors.lastname: Thakar
mesh_terms: D001003:Anal Canal / Q000293:injuries*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004841:Episiotomy; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D009772:Obstetrical Forceps; D011247:Pregnancy; D011256:Pregnancy Outcome; D013536:Suture Techniques; D014947:Wounds and Injuries / Q000150:complications / Q000517:prevention & control / Q000628:therapy
keywords: anal incontinence; anal sphincter injury; end-to-end repair; obstetrical complications; overlap repair; perineal laceration; pregnancy; sphincteroplasty