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Anal Sphincter Injuries After Operative Vaginal Versus Spontaneous Delivery—Is There a Difference in Postpartum Symptoms?

Davé, Bhumy A. MD; Leader-Cramer, Alix MD; Mueller, Margaret MD; Johnson, Lisa Labin MD; Kenton, Kimberly MD, MS; Lewicky-Gaupp, Christina MD

Female Pelvic Medicine & Reconstructive Surgery: July/August 2016 - Volume 22 - Issue 4 - p 194–198
doi: 10.1097/SPV.0000000000000260
AUGS Conference Submission

Objective The aim of this study was to determine whether there is a difference in pelvic floor symptoms between women who had obstetric anal sphincter injuries (OASIS) after an operative vaginal delivery versus those who had OASIS after a spontaneous delivery.

Methods This was a secondary analysis of a prospective cohort study of women who sustained OASIS. Women were evaluated at 1 week postpartum and again at 12 weeks; at both of these visits, they completed a battery of validated questionnaires including a visual analog scale for pain, Patient Health Questionnaire 9 depression inventory, Fecal Incontinence Severity Index, Urogenital Distress Inventory 6, and Incontinence Impact Questionnaire 7.

Results Two hundred sixty-eight women with OASIS were included in this analysis (194 operative vaginal, 74 spontaneous). Ninety-one percent of those with operative vaginal delivery had a forceps-assisted delivery. After multivariate regression, operative OASIS was independently associated with greater Urogenital Distress Inventory 6 scores (P = 0.02), Fecal Incontinence Severity Index scores (P = 0.04), and visual analog scale pain scores (P = 0.03) and higher rates of urgency urinary incontinence (P = 0.04), stress urinary incontinence (P = 0.02), and anal incontinence (P = 0.04) at 1 week postpartum. At 3 months postpartum, symptoms were no different between the groups.

Conclusions Women who sustain OASIS secondary to operative vaginal delivery report more bothersome urinary symptoms and higher rates of anal incontinence immediately postpartum as compared with women with OASIS secondary to spontaneous delivery. These differences may resolve by 3 months postpartum.

Women who sustain OASIS secondary to operative delivery report more bothersome urinary symptoms and higher rates of anal incontinence symptoms immediately postpartum as compared to women with OASIS secondary to spontaneous delivery but these differences may resolve by 3 months postpartum.

From the Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.

Reprints: Bhumy A. Davé, MD, Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 250 E Superior, Suite 05-2370, Chicago, IL 60611. E-mail: bhumydave@gmail.com.

Conflicts of interest and source of funding: Funding was provided by Evergreen Invitational Women’s Health Initiative.

This study was presented at the Pelvic Floor Disorders Week 2015 (formerly AUGS Annual Scientific Meeting), October 13 to 17, 2015, in Seattle, WA.

The authors have declared they have no conflicts of interest.

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