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. 2021 Mar;303(3):709-714.
doi: 10.1007/s00404-020-05806-w. Epub 2020 Sep 25.

Risk factors for obstetric anal sphincter injury among parous women

Gabriel Levin #  1 , Amihai Rottenstreich #  2 , Abraham Tsur  3 , Tal Cahan  3 , Rakefet Yoeli-Ullman  3 , Daniel Shai  3 , Raanan Meyer  3
Affiliations

Risk factors for obstetric anal sphincter injury among parous women

Gabriel Levin et al. Arch Gynecol Obstet. 2021 Mar.

Abstract

Purpose: Nulliparity and operative vaginal delivery are established risk factor for obstetric anal sphincter injury (OASI). However, risk factors for OASIS occurrence among parous women delivering vaginally are not well-established. We aimed to study the risk factors for OASI occurrence among parous women.

Methods: A retrospective study including all parous women who delivered vaginally at term during 2011-2019 at a university hospital. Deliveries of parous women with OASI were compared to deliveries without OASI. The risk factors associated with OASI were investigated.

Results: Overall, 35,397 women were included in the study with an OASI rate of 0.4% (n = 144). A higher rate of only one previous vaginal delivery was noted in the OASI group (78.5% vs. 46.4%, OR [95% CI] 4.20, 2.82-6.25, p < 0.001). The rate of vacuum-assisted deliveries was comparable between the study groups. The median birth weight was higher among the OASI group (3566 vs. 3300 g, p < 0.001), as was the rate of macrosomic neonates (19.4% vs. 5.5%, OR [95% CI] 4.15, 2.74-6.29, p < 0.001). On multivariate logistic regression analysis, only two factors were independently positively associated with the occurrence of OASI: a history of only one previous vaginal delivery (adjusted OR [95% CI] 4.34, 2.90-6.49, p = 0.001), and neonatal birth-weight (for each 500 g increment) (adjusted OR [95% CI] 2.51, 1.84-3.44, p < 0.001).

Conclusions: Among parous women, the only factors found to be independently positively associated with OASI were the order of parity and neonatal birth-weight. Vacuum-assisted delivery was not associated with an increased risk of OASI among parous women.

Keywords: Birthweight; Episiotomy; Obstetric anal sphincter injury; Parity; Parous; Vacuum-assisted delivery.

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