Choice of mode of delivery in a subsequent pregnancy after OASI: a survey among Dutch gynecologists.
OBJECTIVE
National and international guidelines do not provide clear recommendations on the mode of delivery in a subsequent pregnancy after obstetric anal sphincter injury (OASI). The aim of this study was to investigate the opinion of gynecologists in The Netherlands on this choice and the extent to which this choice is affected by the gynecologist's characteristics.


METHODS
Of 973 gynecologists sent a questionnaire seeking their opinion on the mode of delivery in 16 different case descriptions, 234 (24%) responded. Factors influencing the opinion of the respondents on the mode of delivery, the presence of anal symptoms, the degree of OASI and the characteristics of the respondents were analyzed by univariate and multivariate logistic regression analysis.


RESULTS
Recommendations on the mode of delivery in a subsequent pregnancy after OASI showed considerable variation. The recommendations depended on (previous) symptoms and the degree of OASI. For gynecologists who based their recommendations on endoanal ultrasonography outcomes (7-20% depending on the case), the degree of OASI and severity of (previous) symptoms were less important. Gynecologists basing their recommendations on endoanal ultrasonography recommended a primary cesarean section less often. Gynecologist's characteristics (including years of experience, type of hospital and subspecialty) had a small effect on their recommendations on the mode of delivery.


CONCLUSIONS
Due to lack of evidence, recommendations of gynecologists in The Netherlands on the mode of delivery in a subsequent pregnancy after OASI vary widely and depend on (previous) symptoms and the degree of OASI. Gynecologists who based their recommendations on endoanal ultrasonography outcomes recommended cesarean section less often.
Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. judith_donners@hotmail.com.
Judith J A E
JJAE
Donners
Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands.
Kirsten B
KB
Kluivers
Obstetrics and Gynaecology, Ikazia, Rotterdam, Netherlands.
Jan W
JW
de Leeuw
Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands.
Jeroen
J
van Dillen
Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands.
Sander M J
SMJ
van Kuijk
Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
Mirjam
M
Weemhoff
D001003:Anal Canal / Q000293:injuries; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009426:Netherlands; D009774:Obstetrics / Q000706:statistics & numerical data*; D011247:Pregnancy; D011795:Surveys and Questionnaires
Obstetric anal sphincter injury; Subsequent pregnancy