The role of anal manometry in the follow-up of women with obstetric anal sphincter injuries (OASI)

Badri, Hawra; Fowler, Gillian; Lane, Steven

doi:10.1007/s00192-022-05380-6

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…19,20 The distinct role of AM in OASI follow-up has previously been explored by the authors. 21 Our study identified that 66.3% (n = 894) of women in our tertiary unit were asymptomatic at 6 months following primary OASI repair. This is in-keeping with the RCOG quoted range of 60%-80%.…”

Section: Discussionmentioning

confidence: 80%

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Follow up of women after obstetric anal sphincter injuries (OASI)—What is the role of anorectal testing?

Badri

Fowler

Lane

2023

Neurourology and Urodynamics

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Aims To evaluate the benefit of performing anorectal studies on all women following primary obstetric anal sphincter injury (OASI) repair over performing them on symptomatic women only. Methods Women who attended perineal clinic between 2007 and 2020 underwent symptom assessment and anorectal studies at 6 weeks and 6 months postpartum. Anorectal studies including endo anal ultrasound (EAUS) and anal manometry (AM) were performed. The anorectal studies of symptomatic women who were the case group, were compared with asymptomatic women who were the control group. Results A total of 1348 women were seen in the perineal clinic over 13 years. A total of 454 (33.7%) women were symptomatic. A total of 894 (66.3%) women were asymptomatic. A total of 313 (35%) asymptomatic women had two abnormal anorectal studies, 274 (31%) had abnormal AM alone, and 86 (9.6%) had abnormal EAUS alone. A total of 221 (24.7%) asymptomatic women had normal anorectal studies. Conclusion Almost 70% of women were asymptomatic 6 months following primary OASI repair. Most had at least one abnormal anorectal study result. Selectively performing anorectal tests on symptomatic women would not identify asymptomatic women at risk of future faecal incontinence following further vaginal birth. Without anorectal study results, women would not receive accurate counseling about the risks of vaginal birth. Anorectal studies should be offered to all women following OASI where resources allow.

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Section: Discussionmentioning

confidence: 80%

“…Abnormal AM has been identified in symptomatic women with OASI and is associated with the presence of defects on EAUS 19,20 . The distinct role of AM in OASI follow‐up has previously been explored by the authors 21 …”

Section: Discussionmentioning

confidence: 99%

Follow up of women after obstetric anal sphincter injuries (OASI)—What is the role of anorectal testing?

Badri

Fowler

Lane

2023

Neurourology and Urodynamics

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“…A 2014 survey of UK women demonstrated that only one third had access to a perineal clinic, and less than one fifth had access to endoanal ultrasound after OASI (14). Protocols outlining interpretation of anorectal investigations to directivity counsel women on planned mode of birth (MOB) after OASI differ between units (11,15,16,17,18,19). Evidence suggests that the majority of women in the UK are counselled regarding subsequent MOB based on their symptoms and preferences alone (14).…”

Section: Introductionmentioning

confidence: 99%

Is Cesarean Section Protective against Anal Incontinence in Women after Obstetric Anal Sphincter Injury (OASI)? A Systematic Review and Meta-Analysis

Carter,

Hall,

Ajoku

et al. 2023

Preprint

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Objective: Approximately 50% women who give birth after Obstetric Anal Sphincter Injury (OASI) develop anal incontinence (AI) over their lifetime. We review current evidence for protective benefit of planned cesarean section (CS) to prevent AI after OASI. Design and setting: Systematic review and meta-analysis according to prospectively published methodology. Population and methods: All studies reporting outcomes after an OASI and subsequent birth by any mode. Main outcome measures: AI measurement after OASI and subsequent birth. Total AI, new/worsening AI, quality of life, satisfaction, regret. Results: 86 of 2472 screened studies met inclusion criteria. All studies contributing to meta-analyses were at high risk of bias. There was no evidence of difference in new or worsening AI after subsequent vaginal birth (VB) compared to subsequent CS after OASI across all time periods (p=0.53: CI 0.72-1.19; 9 studies, 2104 participants); ≤2y (p=0.83: CI 0.65-1.72; 7 studies, 569 participants) or ≥5y after subsequent birth (p=0.39: CI 0.65-1.18; 2 studies; 1535 participants). There was no difference between subsequent CS or VB in asymptomatic women or for other AI or QOL outcomes. There was no evidence of difference in AI in women who subsequently delivered vs those who did not (p=0.9: CI 0.71-1.34; 10 studies, 970 participants); or pre- subsequent birth vs post-subsequent birth (p=0.31; CI 0.51-1.25, 13 studies, 5496 participants). Conclusions: Due to evidence quality (majority non-randomised studies) we are unable to determine whether planned cesarean is protective against AI after OASI. Higher quality data is required to guide practice in this area, specifically in asymptomatic women and for long-term outcomes.

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Anorectal manometry — How to perform and interpret manometry

Gala,

Johnston,

Solanki

et al. 2024

Continence

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The role of anal manometry in the follow-up of women with obstetric anal sphincter injuries (OASI)

Cited by 4 publications

References 29 publications

Follow up of women after obstetric anal sphincter injuries (OASI)—What is the role of anorectal testing?

Follow up of women after obstetric anal sphincter injuries (OASI)—What is the role of anorectal testing?

Is Cesarean Section Protective against Anal Incontinence in Women after Obstetric Anal Sphincter Injury (OASI)? A Systematic Review and Meta-Analysis

Anorectal manometry — How to perform and interpret manometry

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