干旱区生态环境知识资源中心(Arid): Management of subsequent pregnancies following fourth-degree obstetric anal sphincter injuries (OASIS)

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DOI	10.1016/j.ejogrb.2020.04.063
	Management of subsequent pregnancies following fourth-degree obstetric anal sphincter injuries (OASIS)
	Taithongchai, Annika; Thakar, Ranee; Sultan, Abdul H.
通讯作者	Sultan, AH
来源期刊	EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY
ISSN	0301-2115
EISSN	1872-7654
出版年	2020
卷号	250 页码:80-85
英文摘要	Objectives: The management of subsequent pregnancy in women who sustained OASIS remains an enigma. Nearly all studies include all grades of OASIS including fourth-degree tears. In addition, most protocols require endoanal ultrasound and anal manometric assessment to provide advice regarding mode of delivery. In reality, most women who sustain an OASI do not undergo these investigations. The aims of our study were firstly to evaluate outcomes of fourth-degree OASIS in terms of sphincter defects, anal manometry and anal incontinence symptoms. Secondly, we wished to review recommendations made regarding subsequent mode of delivery after fourth-degree OASIS according to different published protocols. Study design: An observational study of all women who had undergone a primary repair of a fourth-degree tear and seen in the perineal clinic of a tertiary urogynaecology unit between January 2006 and December 2017. Three-dimensional endoanal ultrasound and anal manometry were performed on all women, and symptoms assessed using the validated modified St Mark's Score for anal incontinence. Diagnostic test accuracy analysis was performed for use of symptoms in predicting abnormal investigations. Results: 74 fourth-degree tears were identified (mean follow-up 5.9 months; SD 11.5). Endoanal scan showed an internal anal sphincter defect in 77 % and an external anal sphincter defect in 49 %. Only 18 % had no defect. The mean incremental pressure rise was 12.6 mmHg (SD 15.5). 61 % were asymptomatic with a mean St Mark's Score of 3.8 (SD 5.4). The presence of symptoms alone had poor accuracy in predicting abnormal investigations. Based on Royal College of Obstetricians and Gynaecologists guidance, only 7% would not be offered a caesarean section as they are asymptomatic women with normal scan and manometry findings and would be counselled for a vaginal delivery. Conclusions: Given that only a few units offer these specialist investigations to their OASI population, it would be reasonable to offer caesarean section to all women who have sustained a fourth-degree tear. However, in centres where endoanal ultrasound and anal manometry are available, individualised counselling can be offered. Crown Copyright (C) 2020 Published by Elsevier B.V. All rights reserved.
英文关键词	Obstetric anal sphincter injury Fourth-degree tear Mode of delivery Endoanal ultrasound Anorectal manometry
类型	Article ; Proceedings Paper
语种	英语
收录类别	SCI-E
WOS记录号	WOS:000573025800014
WOS关键词	PRIMARY REPAIR ; DELIVERY ; MODE ; SYMPTOMS ; DEFECTS ; RUPTURE ; WOMEN
WOS类目	Obstetrics & Gynecology ; Reproductive Biology
WOS研究方向	Obstetrics & Gynecology ; Reproductive Biology
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/326524
作者单位	[Taithongchai, Annika; Thakar, Ranee; Sultan, Abdul H.] Croydon Univ Hosp, 530 London Rd, London CR5 7YE, England; [Sultan, Abdul H.] St Georges Univ London, London, England
推荐引用方式 GB/T 7714	Taithongchai, Annika,Thakar, Ranee,Sultan, Abdul H.. Management of subsequent pregnancies following fourth-degree obstetric anal sphincter injuries (OASIS)[J],2020,250:80-85.
APA	Taithongchai, Annika,Thakar, Ranee,&Sultan, Abdul H..(2020).Management of subsequent pregnancies following fourth-degree obstetric anal sphincter injuries (OASIS).EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY,250,80-85.
MLA	Taithongchai, Annika,et al."Management of subsequent pregnancies following fourth-degree obstetric anal sphincter injuries (OASIS)".EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY 250(2020):80-85.