Top

Published in:

Open Access 01-10-2017 | Original Article

Choice of mode of delivery in a subsequent pregnancy after OASI: a survey among Dutch gynecologists

Authors: Judith J. A. E. Donners, Kirsten B. Kluivers, Jan W. de Leeuw, Jeroen van Dillen, Sander M. J. van Kuijk, Mirjam Weemhoff

Published in: International Urogynecology Journal | Issue 10/2017

Abstract

Introduction and hypothesis

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.

Bek KM, Laurberg S. Risk of anal incontinence from subsequent vaginal delivery after a complete obstetric anal sphincter tear. Br J Obstet Gynaecol. 1992;99(9):724–726.CrossRefPubMed

Nordenstam J, Altman D, Brismar S, Zetterstrom J. Natural progression of anal incontinence after childbirth. Int Urogynecol J. 2009;20(9):1029–1035.CrossRef

Scheer I, Thakar R, Sultan AH. Mode of delivery after previous obstetric anal sphincter injuries (OASIS) – a reappraisal? Int Urogynecol J. 2009;20(9):1095–1101.CrossRef

Tetzschner T, Sorensen M, Lose G, Christiansen J. Anal and urinary incontinence in women with obstetric anal sphincter rupture. Br J Obstet Gynaecol. 1996;103(10):1034–1040.CrossRefPubMed

Jangö H, Langhoff-Roos J, Rosthoj S, Sakse A. Mode of delivery after obstetric anal sphincter injury and risk of long-term anal incontinence. Am J Obstet Gynecol. 2016;214:733.e1–733.e13.CrossRef

Fitzpatrick M, Cassidy M, Barassaud ML, Hehir MP, Hanly AM, O’Connell PR, et al. Does anal sphincter injury preclude subsequent vaginal delivery? Eur J Obstet Gynecol Reprod Biol. 2015;198:30–34.CrossRef

Nederlandse Vereniging voor Obstetrie en Gynaecologie (2013) Totaalruptuur versie 1.0. http://richtlijnendatabase.nl/richtlijn/totaalruptuur/risicofactoren_en_preventie_van_totaalruptuur.html. Accessed 28 Feb 2017.

Royal College of Obstetricians & Gynaecologists (2015) Third- and fourth-degree perineal tears, management (green top guideline no. 29). https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg29. Accessed 28 Feb 2017.

Sultan AH. Editorial: Obstetrical perineal injury and anal incontinence. Clin Risk. 1999;5:193–196.

10.

Oude Lohuis EJ, Everhardt E. Outcome of obstetric anal sphincter injuries in terms of persisting endoanal ultrasonographic defects and defecatory symptoms. Int J Gynecol Obstet. 2014;126:70–73.CrossRef

11.

NVOGledenlijst. http://www.nvog.nl/voorLeden/default.aspx?ReferrerQueryString=ChapterID%3d902%26ChapterID%3d5%26amp%253bContentID%3d1898%26amp%253bFilterID%3d1%26amp%253bReferrerQueryString%3dChapterID%253d902%2526link%253d1.

Title: Choice of mode of delivery in a subsequent pregnancy after OASI: a survey among Dutch gynecologists
Authors: Judith J. A. E. Donners
Kirsten B. Kluivers
Jan W. de Leeuw
Jeroen van Dillen
Sander M. J. van Kuijk
Mirjam Weemhoff
Publication date: 01-10-2017
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 10/2017
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-017-3304-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Choice of mode of delivery in a subsequent pregnancy after OASI: a survey among Dutch gynecologists

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2017

Pelvic organ support several years after a first birth

Vaginal repair of a vesicocervical fistula after labored-cesarean delivery without concomitant hysterectomy

Two techniques for assessing postoperative voiding function, a randomized trial

Effect of pessary use on hydronephrosis in women with advanced pelvic organ prolapse: a self-selected interventional trial

Urogynecology digest

Labia minora hypertrophy: causes, impact on women’s health, and treatment options