Perineal and anal sphincter obstetric injury

Abstract

Perineal repair after childbirth affects millions of women worldwide. The prevalence of perineal trauma varies as it is dependent on obstetric practice including rates and types of episiotomy. Obstetric anal sphincter injuries (OASIS) occur in 1.7 % (2.9 % in primiparae) of women in centres where mediolateral episiotomies are practiced compared to 12–19 % (19 % in primiparae) in centres practicing midline episiotomy. It has been shown that up to half of OASIS are not recognized by the accoucher. Inadequate training of doctors and midwives in perineal and anal sphincter anatomy is believed to be a major contributing factor. However, despite recognition and primary repair of acute OASIS, 39–61 % have symptoms of anal incontinence and 92 % have persistent anal sphincter defects on ultrasound within 3 months of delivery. The morbidity associated with perineal trauma depends on the extent of perineal damage, technique and materials used for suturing and the skill of the person performing the procedure. Unfortunately, there is no standardized approach to prevention and repair of perineal trauma and episiotomy.