Service de chirurgie gynécologique, CHU Lille, Lille, F-59000, France.
Faculté de médecine, Univ. Lille, Lille, F-59000, France.
BMC Pregnancy Childbirth. 2024 Aug 14;24(1):539. doi: 10.1186/s12884-024-06691-w.
Incidence of complications following obstetrical anal sphincter injury (OASI) during vaginal delivery are poorly defined. They are only studied in high level maternities, small cohorts, all stages of perineal tear or in low-income countries. The aim of our study was to describe complications after primary OASI repair following a vaginal delivery in all French maternity wards at short and midterm and to assess factors associated with complication occurrence.
We conducted a historical cohort study using the French nationwide claim database (PMSI) from January 2013 to December 2021. All women who sustained an OASI repair following a vaginal delivery were included and virtually followed-up for 2 years. Then, we searched for OASIS complications. Finally, we evaluated factors associated with OASIS complication repaired or not and OASIS complication repairs.
Among the 61,833 included women, 2015 (2.8%) had an OASI complication and 842 (1.16%) underwent an OASI complication repair. Women were mainly primiparous (71.6%) and 44.3% underwent an instrumental delivery. During a follow-up of 2 years, 0.6% (n = 463), 0.3% (n = 240), 0.2% (n = 176), 0.1% (n = 84), 0.06% (n = 43) and 0.01% (n = 5) of patients underwent second surgery for a perineal repair, a fistula repair, a sphincteroplasty, a perineal infection, a colostomy and a sacral nervous anal stimulation, respectively. Only one case of artificial anal sphincter was noticed. Instrumental deliveries (OR = 1.56 CI95%[1.29;1.9]), private for-profit hospitals (OR = 1.42 [1.11;1.82], reference group "public hospital"), obesity (OR = 1.36 [1;1.84]), stage IV OASIS (OR = 2.98 [2.4;3.72]), perineal wound breakdown (OR = 2.8 [1.4;5.48]), ages between 25 and 29 years old (OR = 1.59 [1.17;2.18], refence group "age between 13 and 24 years old") and 30 and 34 years old (OR = 1.57 [1.14; 2.16], refence group "age between 13 and 24 years old") were factors associated with OASIS complication repairs.
Maternal age, stage IV OASIS, obesity, instrumental deliveries and private for-profit hospitals seemed to predict OASIS complications. Understanding factors associated with OASIS complications could be beneficial for the patient to inform them and to influence the patient's follow-up in order to prevent complications, repairs and maternal distress.
阴道分娩后发生产科肛门括约肌损伤（OASI）相关并发症的发生率定义不明确。这些并发症仅在高水平的产科、小队列、所有会阴撕裂程度或在低收入国家中进行研究。我们的研究目的是描述所有法国产科病房在短期和中期阴道分娩后初次 OASI 修复后的并发症，并评估与并发症发生相关的因素。
我们使用法国全国索赔数据库（PMSI）进行了一项历史性队列研究，时间范围为 2013 年 1 月至 2021 年 12 月。纳入所有接受阴道分娩后 OASI 修复的女性，并对其进行虚拟随访 2 年。然后，我们搜索 OASIS 并发症。最后，我们评估了与 OASI 并发症修复或不修复以及 OASI 并发症修复相关的因素。
在纳入的 61833 名女性中，2015 年（2.8%）发生了 OASI 并发症，842 名（1.16%）接受了 OASI 并发症修复。女性主要为初产妇（71.6%），44.3%接受了器械分娩。在 2 年的随访中，0.6%（n=463）、0.3%（n=240）、0.2%（n=176）、0.1%（n=84）、0.06%（n=43）和 0.01%（n=5）的患者分别接受了会阴修复、瘘管修复、括约肌成形术、会阴感染、结肠造口术和骶神经肛门刺激的二次手术。仅注意到 1 例人工肛门括约肌。器械分娩（OR=1.56 CI95%[1.29;1.9]）、私立营利性医院（OR=1.42 [1.11;1.82]，参考组“公立医院”）、肥胖（OR=1.36 [1;1.84]）、OASI Ⅳ期（OR=2.98 [2.4;3.72]）、会阴伤口破裂（OR=2.8 [1.4;5.48]）、25-29 岁年龄组（OR=1.59 [1.17;2.18]，参考组“13-24 岁年龄组”）和 30-34 岁年龄组（OR=1.57 [1.14; 2.16]，参考组“13-24 岁年龄组”）是与 OASI 并发症修复相关的因素。
产妇年龄、OASI Ⅳ期、肥胖、器械分娩和私立营利性医院似乎可预测 OASI 并发症。了解 OASI 并发症相关因素可使患者受益，以便对其进行告知，并影响患者的随访，以预防并发症、修复和产妇痛苦。
