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Obstetric Anal Sphincter Injuries at Vaginal Delivery

A Review of Recently Published National Guidelines

Tsakiridis, Ioannis MSc*; Mamopoulos, Apostolos PhD; Athanasiadis, Apostolos PhD; Dagklis, Themistoklis PhD§

Obstetrical & Gynecological Survey: December 2018 - Volume 73 - Issue 12 - p 695–702
doi: 10.1097/OGX.0000000000000622

Importance Obstetric anal sphincter injuries (OASISs) complicate approximately 1 in 10 deliveries.

Objective The aims of this study were to review and compare recommendations from recently published national guidelines regarding OASISs at vaginal delivery.

Evidence Acquisition Three national guidelines on OASISs at vaginal delivery are presented through a descriptive review: Royal College of Obstetricians and Gynaecologists on “The Management of Third- and Fourth-Degree Perineal Tears,” American College of Obstetricians and Gynecologists on “Prevention and Management of Obstetric Lacerations at Vaginal Delivery,” and Society of Obstetricians and Gynaecologists of Canada on “Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair.” These guidelines were summarized and compared in terms of prevention and management of OASISs. Quality of evidence was also reviewed based on method of reporting for each guideline.

Results This published evidence reflects the differences between the national recommendations on the prevention and management of OASISs. Especially, as for the prevention of OASIS, routine use of episiotomy is not recommended, whereas warm perineal compresses and perineal massage during the second stage of labor seem to have a protective role. In the management of OASIS, special care is needed during the repair process of the torn anorectal mucosa and the internal and external anal sphincter. The postoperative use of broad-spectrum antibiotics, oral laxatives, and analgesia is also recommended.

Conclusions Summarized guidelines can have an impact on special care in prevention and management of OASIS; this may support the reduction of morbidity associated with that entity.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After participating in this activity, the learner should be better able to evaluate prevention strategies on OASISs in the antenatal and intrapartum period; compare management recommendations in cases of OASISs; and plan the appropriate consultation regarding future pregnancies and postpartum care in cases of OASISs.

*Resident Assistant,

Associate Professor,

Professor, and

§Consultant in Maternal-Fetal Medicine, Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

All authors,faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this educational activity.

Correspondence requests to: Ioannis Tsakiridis, MSc, Konstantinoupoleos 49, 54642, Thessaloniki, Greece. E-mail:

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.