ABSTRACT
INTRODUCTION AND HYPOTHESIS: Women with a history of obstetric anal sphincter injury (OASI) are at increased risk of recurrence (rOASI) at subsequent delivery; however, evidence regarding the factors influencing this risk is limited. Furthermore, little is known about what factors influence the decision to alternatively deliver by elective caesarean section (ELLSCS). METHODS: Retrospective univariate and multivariate logistic regression analysis of prospectively collected data from four NHS electronic maternity databases including primiparous women sustaining OASIS during a singleton, term, cephalic, vaginal delivery between 2004 and 2015, who had a subsequent delivery. RESULTS: Two thousand two hundred seventy-two women met the criteria; 10.2% delivering vaginally had a repeat OASI and 59.4% had a second-degree tear. Women having an ELLSCS were more likely to be Caucasian, older, have previously had an operative vaginal delivery (OVD) and have a more severe degree of OASI. Positive predictors for rOASI were increased birth weight and maternal age at both index and subsequent deliveries, a more severe degree of initial OASI and Asian ethnicity. The overall mediolateral episiotomy (MLE) rate was 15.6%; 77.2% of those who had an episiotomy sustained no spontaneous perineal trauma. Only 4.4% of women with a rOASI had an MLE, whilst the MLE rate was 16.9% in those without a recurrence (p < 0.001). MLE decreased the risk of rOASI by 80%. Birth weight > 4 kg increased the risk 2.5 fold. CONCLUSIONS: Women with previous OASIS are at an increased risk of recurrence. A more liberal use of MLE during subsequent vaginal delivery could significantly reduce the risk of recurrence.
Subject(s)
Anal Canal , Obstetric Labor Complications , Cesarean Section/adverse effects , Delivery, Obstetric/adverse effects , Episiotomy/adverse effects , Female , Humans , Obstetric Labor Complications/epidemiology , Obstetric Labor Complications/etiology , Pregnancy , Retrospective Studies , Risk FactorsSubject(s)
Laser Therapy , Vagina/pathology , Vaginal Diseases/surgery , Atrophy/surgery , Female , Humans , Vagina/surgeryABSTRACT
Standards are an important way of demonstrating quality of care in any given setting. The British Menopause Society (BMS) has produced guidelines as to what should be recorded at the initial menopause consultation. A retrospective audit of case-notes of women attending Poole Menopause Centre was undertaken using these criteria as audit standards. Although areas of good practice were highlighted, the published criteria were met for only five of the 23 standards. An action plan to improve the documentation to achieve these standards has been formulated.
