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Review
. 2021 Jul 23;10(15):3261.
doi: 10.3390/jcm10153261.

Diagnosis and Treatment of Obstetric Anal Sphincter Injuries: New Evidence and Perspectives

Antonino Spinelli  1   2 , Virginia Laurenti  1   2 , Francesco Maria Carrano  1   2 , Enrique Gonzalez-Díaz  3   4 , Katarzyna Borycka-Kiciak  5
Affiliations
Review

Diagnosis and Treatment of Obstetric Anal Sphincter Injuries: New Evidence and Perspectives

Antonino Spinelli et al. J Clin Med. .

Abstract

Perineal injury during childbirth is a common event with important morbidity associated in particular with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries-OASIS). Early diagnosis of these damages is mandatory to define a prompt therapeutic strategy and thus avoid the development of late-onset consequences, such as faecal incontinence. For this purpose, various diagnostic exams can be performed after a thorough clinical examination. The management of OASIS includes several measures and should be individualized according to the timing and features of the clinical presentation.

Keywords: anal sphincter; diagnostics; faecal incontinence; obstetric anal sphincter injury (OASI); perineal tear; treatment.

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Conflict of interest statement

K.B.-K. is a leader of the OASIS Diagnostics project, an author of the related patent, and shareholder of OASIS Diagnostics SA.; independent consultant and trainer of Takeda; and expert of national Medical Research Agency. A.S. is an independent consultant of OASIS Diagnostics SA., Ethicon, Frankenman. All received no remuneration on performing these studies. Others declare no conflict of interest. The funders had no role in the design of the studies; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Acknowledged risk factors for the development of OASIS.
Figure 2
Figure 2
Mediolateral episiotomy with an angle of 45–60 degrees from the midline.
Figure 3
Figure 3
Tomographic ultrasound imaging of internal (IAS) and external anal sphincter (EAS). Longitudinal plane encompassing entire length of EAS is used as reference frame (upper left image of both pictures). The EAS appears as a ring of hyperechogenicity surrounding the thin hypoechogenic ring of the IAS. The mucosal folds of the anal canal appear in the center of the image as the innermost layer. Sphincters are normal in all the transverse slices of the left picture (complete rings). The picture on the right show a full-thickness defect of both sphincters (both concentric rings are interrupted).
Figure 4
Figure 4
Methods for surgical repair of anal sphincter tears: Overlap technique (images on the left) and end-to-end technique (images on the right).
Figure 5
Figure 5
Proposed algorithm for the management of OASIS. OASIS: obstetric anal sphincter injuries. FI: fecal incontinence. PFPT: pelvic floor physical therapy. SNM: sacral nerve modulation.
See this image and copyright information in PMC

References

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