From the Department of Obstetrics and Gynecology and Women's Health.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center.
Female Pelvic Med Reconstr Surg. 2021 Jan 1;27(1):e146-e151. doi: 10.1097/SPV.0000000000000867.
Obstetric anal sphincter injuries (OASIs) are severe tears involving the external and internal anal sphincters. We aimed to document the incidence of OASIs within a racially and ethnically diverse institution to elucidate which maternal, fetal, and parturition factors may be associated with OASIs in minority subgroups.
This was a retrospective unmatched case-control study of reproductive aged women who delivered between January 1, 2014, and December 31, 2017, at our institution. Data for maternal, fetal, and parturition factors were gathered through chart review. We also investigated the expertise level of the surgeon performing repairs and complications that developed in the postpartum period. Logistic regression analysis was used to compare women with third- and fourth-degree lacerations against the control group of women with first-degree, second-degree, or no lacerations.
Of the 23,362 deliveries between January 1, 2014, and December 31, 2017, the incidence of OASIs was 1%. Of our patients, 38% self-identified as Hispanic, 32% as Black, 13% as White, and 3.5% as Asian. Risk for OASIs was significantly increased in nulliparity, Pitocin use, operative deliveries, episiotomy, and prolonged second stage of labor. Black race and obesity were protective for OASIs. There was no significant difference in complication rates based on type of repair nor the provider level of training.
The incidence of OASIs at our institution is similar to current published literature. Our study population is unique in its overrepresentation of minority groups, offering insight into potentially distinctive risk and protective factors associated with OASIs.
产科肛门括约肌损伤（OASIs）是一种严重的撕裂，涉及肛门外括约肌和肛门内括约肌。我们旨在记录一个种族和民族多样化的机构中 OASIs 的发生率，以阐明哪些产妇、胎儿和分娩因素可能与少数民族亚组的 OASIs 相关。
这是一项回顾性的、不匹配的病例对照研究，研究对象为 2014 年 1 月 1 日至 2017 年 12 月 31 日期间在我们机构分娩的育龄妇女。通过病历回顾收集产妇、胎儿和分娩因素的数据。我们还研究了进行修复手术的外科医生的专业水平以及产后出现的并发症。使用逻辑回归分析比较三、四级裂伤的女性与一级、二级或无裂伤的对照组女性。
在 2014 年 1 月 1 日至 2017 年 12 月 31 日期间的 23362 次分娩中，OASIs 的发生率为 1%。我们的患者中，38%自我认同为西班牙裔，32%为黑人，13%为白人，3.5%为亚洲人。OASIs 的风险在初产妇、催产素使用、剖宫产、会阴切开术和第二产程延长中显著增加。黑人种族和肥胖是 OASIs 的保护因素。根据修复类型和提供者的培训水平，并发症发生率没有显著差异。
我们机构的 OASIs 发生率与目前已发表的文献相似。我们的研究人群以少数民族群体的代表性过高为特点，深入了解与 OASIs 相关的潜在独特风险和保护因素。
