The IUGA Research & Development Committee is seeking for 3 to 5 volunteers to contribute to the development of an opinion paper on the Mode of Subsequent Delivery After Obstetrical Anal Sphincter Injuries (OASIS).
Obstetrical Anal Sphincter Injuries (OASIS) are severe perineal lacerations, which have a significant impact on quality of life. The rates of OASIS have been increasing worldwide due to improved awareness, recognition, and reporting. Sixty percent of women with OASIS have a subsequent pregnancy.1 When these women conceive again, they are faced with a dilemma regarding the most appropriate mode of delivery. Although counseling about mode of delivery influenced decision in 34.9% of women,2 there is a large variation in clinical practice and advice provided to women.3 Currently, there are no Randomized Controlled Trials that assess the optimal mode of delivery for subsequent pregnancy post-OASIS and such a trial would not be feasible.4 A 2017 systematic review and meta-analysis by Webb et al. concluded that due to sample size, quality, and heterogeneity of available studies, the optimal mode of delivery for women with previous OASIS remains unknown.5 While most women are good candidates for vaginal delivery,5 there is evidence that women with prior OASIS are more likely to have an elective cesarean section.6
PICO Question: ““What is the recommended mode of subsequent delivery for women with previous Obstetrical Anal Sphincter Injuries (OASIS)?”
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Population: women with previous OASIS based on grade – major (3c or 4th) or minor (3a or 3b)
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Intervention: subsequent mode of delivery
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Comparison: mode of delivery (vaginal delivery; spontaneous or instrumental, vs cesarean section)
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Outcome Measures:
- Impact of subsequent delivery on pelvic floor dysfunction; anorectal symptoms, sexual function, and quality of life
- Women’s regret about subsequent mode of delivery and factors influencing this decision
- Incidence of recurrent OASIS
Timeline:
This project is expected to begin in August 2022 and conclude by August 2023.
Contributor Expectations:
- The manuscript will be developed using a collaborative process that requires regular communication via email, possible conference calls, and completion of assignments.
- Contributors will produce and deliver all completed assignments and required information on or before the agreed deadlines.
- Contributors will disclose all potential conflicts of interest (see Conflict of Interest Policy here).
Eligibility
Current IUGA members are eligible to apply.
How to Apply:
Please submit the following to
1. A letter of interest that includes your qualifications and experience related to this topic
2. Your CV
3. Complete the Disclosure Form
Application Deadline:
Applications must be received by 11:59pm CET on Wednesday, June 8, 2022
References:
- Fradet-Menard C, Deparis J, Gachon B, Sichitiu J, Pierre F, Fritel X, et al. Obstetrical anal sphincter injuries and symptoms after subsequent deliveries: A 60 patient study. Eur J Obstet Gynecol Reprod Biol. 2018;226:40-6.
- Edwards M, Kobernik EK, Suresh S, Swenson CW. Do women with prior obstetrical anal sphincter injury regret having a subsequent vaginal delivery? BMC Pregnancy Childbirth. 2019;19(1):225.
- Sangalli MR, Floris L, Faltin D, Weil A. Anal incontinence in women with third or fourth degree perineal tears and subsequent vaginal deliveries. Aust N Z J Obstet Gynaecol. 2000;40(3):244-8.
- van der Vlist M, Oom D, van Rosmalen J, van Ovost A, Hogewoning C. Parturition mode recommendation and symptoms of pelvic floor disorders after obstetric anal sphincter injuries. Int Urogynecol J. 2020;31(11):2353-9.
- Webb SS, Yates D, Manresa M, Parsons M, MacArthur C, Ismail KM. Impact of subsequent birth and delivery mode for women with previous OASIS: systematic review and meta-analysis. Int Urogynecol J. 2017;28(4):507-14.
- Jha S, Parker V. Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis. Int Urogynecol J. 2016;27(6):849-57.