Djusad Suskhan, Liem Raissa
Department of Obstetrics and Gynecology, dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Eur J Obstet Gynecol Reprod Biol X. 2020 Jun 18;7:100112. doi: 10.1016/j.eurox.2020.100112. eCollection 2020 Jul.
Obstetric Anal Sphincter Injuries (OASIS) is a common complication of vaginal delivery. The incidence was 4.53 % of total vaginal deliveries. OASIS is associated with an increased risk of fecal incontinence (FI), which affects one's quality of life. The incidence of OASIS and FI varied from study to study. In this study, we described the characteristics of patients with OASIS at three Indonesian tertiary hospitals in 2014-2016 and FI outcome among those patients.
This is a descriptive study on the characteristics of OASIS patients after primary repair in three tertiary hospitals: dr. Cipto Mangunkusumo National General Hospital, Persahabatan General Hospital and Fatmawati General Hospital from 2014 to 2016. From a total of 234 patients, only 58 patients could be contacted and interviewed using Revised Fecal Incontinence Score (RFIS) questionnaires. Out of the 58 patients, only 16 patients came for transperineal ultrasound. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 20.
From a total of 234 patients, the mean age was 26.6 years old with a mean Body Mass Index (BMI) of 24.8 kg/m. Most of the patients were nulliparous (67.5 %) and the median duration of second stage of labor was 45 min. Episiotomy was not performed on most patients (59.4 %) and most of them underwent spontaneous vaginal delivery (65.4 %) with mean baby's birthweight of 3217 g. From 58 interviewed patients, three patients complained of FI (5.2 %). Sixteen patients came for transperineal ultrasound examination, and only one of them had FI. Anal sphincter defects were identified in five patients, comprising three external anal sphincter (EAS) and two internal anal sphincter (IAS) defects. All five patients did not experience FI. One patient who had FI had no anal sphincter defect.
This is a pilot study for the incidence of FI among the OASIS population in Jakarta, Indonesia. The incidence of FI observed in this study was relatively low (3 out of 58 patients) compared to other studies. This could be due to differences in study population. The fact that the patient with FI had intact anal sphincter suggests that other factors may contribute to the development of FI in addition to the integrity of the anal sphincter. These factors may include pelvic floor muscle and innervation of the surrounding tissues.
The outcomes of primary repair of OASIS varied between studies. Patients' characteristics might play an important role in the development of OASIS as well as the outcome after repair. Further studies with larger sample size are needed.
产科肛门括约肌损伤（OASIS）是阴道分娩的常见并发症。其发生率占阴道分娩总数的4.53%。OASIS与粪失禁（FI）风险增加相关，这会影响患者的生活质量。不同研究中OASIS和FI的发生率有所不同。在本研究中，我们描述了2014 - 2016年印度尼西亚三家三级医院中OASIS患者的特征以及这些患者的FI结局。
这是一项对三家三级医院中OASIS患者一期修复后特征的描述性研究，这三家医院分别是：西托·曼古库苏莫国家综合医院、佩尔萨哈巴坦综合医院和法特玛瓦蒂综合医院，研究时间为2014年至2016年。在总共234例患者中，仅58例患者能够通过修订的粪失禁评分（RFIS）问卷进行联系和访谈。在这58例患者中，只有16例前来接受经会阴超声检查。使用社会科学统计软件包（SPSS）20版对数据进行分析。
在总共234例患者中，平均年龄为26.6岁，平均体重指数（BMI）为24.8kg/m²。大多数患者为初产妇（67.5%），第二产程的中位持续时间为45分钟。大多数患者未行会阴切开术（59.4%），且大多数患者经阴道自然分娩（65.4%），婴儿平均出生体重为3217g。在接受访谈的58例患者中，3例患者主诉有FI（5.2%）。16例患者前来接受经会阴超声检查，其中只有1例有FI。在5例患者中发现肛门括约肌缺陷，包括3例肛门外括约肌（EAS）缺陷和2例肛门内括约肌（IAS）缺陷。所有5例患者均未出现FI。1例有FI的患者没有肛门括约肌缺陷。
这是一项关于印度尼西亚雅加达OASIS人群中FI发生率的初步研究。与其他研究相比，本研究中观察到的FI发生率相对较低（在58例患者中有3例）。这可能是由于研究人群的差异。有FI的患者肛门括约肌完整这一事实表明，除了肛门括约肌的完整性外，其他因素可能也会导致FI的发生。这些因素可能包括盆底肌肉和周围组织的神经支配。
不同研究中OASIS一期修复的结局有所不同。患者特征可能在OASIS的发生以及修复后的结局中起重要作用。需要进行更大样本量的进一步研究。
