12) Postnatal Care - Obstetric anal sphincter injury and consent guidance Flashcards Preview

Laura MRCOG Part 2 > 12) Postnatal Care - Obstetric anal sphincter injury and consent guidance > Flashcards

Flashcards in 12) Postnatal Care - Obstetric anal sphincter injury and consent guidance Deck (23)
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1
Q

Overall incidence of OASI

A

2.9%

2
Q

Incidence of OASI in primiparous women

A

6.1%

3
Q

Incidence of OASI in multiparous women

A

1.7%

4
Q

What percentage of women giving birth vaginally will tear to some degree?

A

90%

5
Q

Classification of perineal trauma

A

1st: Perineal skin or vaginal mucosa
2nd: Perineal muscles
3A: <50% EAS
3B: >50% EAS
3C: IAS
4: EAS, IAS, anorectal mucosa

Rectal buttonhole tear: Anorectal mucosa but not EAS/IAS.

6
Q

Risk factors for OASI

A
Asian
Nulliparous
EFW >4kg
Shoulder dystopia
OP position
Prolonged 2nd stage
Instrumental delivery
7
Q

Things to prevent OASI

A

RML episiotomy with instrumental deliveries
Perineal massage antenatal
Warm compress during second stage
Hands on approach to delivery

8
Q

How to repair OASI?

A

Anorectal mucosa: Vicryl 3-0. Continuous or interrupted.

IAS: Vicryl 2-0 or PDS 3-0. Interrupted or mattress sutures. End-to-end.

EAS: Vicryl 2-0 or PDS 3-0. Full thickness: Overlapping or end-to-end. Partial thickness: End-to-end.

9
Q

Type of suture PDS and Vicryl

A

PDS monofilament.

Vicryl braided.

10
Q

Rate of suture migration

A

7%

11
Q

Post-op care

A

Antibiotics
Stool softener
Physiotherapy
Follow up 6-12 weeks

12
Q

What percentage of OASI repairs are asymptomatic at 12 months?

A

60-80%

13
Q

Recurrence rate for OASI

A

5-7%

14
Q

Risk of worsening faecal symptoms after subsequent vaginal delivery

A

17% (mostly in women who were initially symptomatic but symptoms resolved by 6m PP)

15
Q

When to consider ELCS?

A

Symptomatic or abnormal anal manometry or abnormal endoanal USS.

16
Q

Percentage of women choosing ELCS after an OASI in first delivery

A

25%

17
Q

Risk of faecal urgency

A

26%

18
Q

Risk of perineal pain/dyspareunia

A

9%

19
Q

Risk of wound infection

A

8%

20
Q

Which risks of OASI repair are common?

A
Incontinence faeces/flatus .
Urgency faeces/flatus
Difficulty opening bowels initially.
Wound infection.
Urine infection.
Pain/dyspareunia.
Suture removal required.
21
Q

Which risks of OASI repair are uncommon?

A

Recommendation to deliver by CS in future.

22
Q

Which risks of OASI repair are rare?

A

Haematoma

Failure of repair

23
Q

Which risks of OASI repair are very rare?

A

Fistula formation

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