Globerman Dobrochna, Ramirez Alison Carter, Larouche Maryse, Pascali Dante, Dufour Sinead, Giroux Maria
Winnipeg, MB.
Calgary, AB.
J Obstet Gynaecol Can. 2024 Dec;46(12):102719. doi: 10.1016/j.jogc.2024.102719. Epub 2024 Nov 23.
The purpose of this guideline is to promote recognition and preventive strategies for obstetrical anal sphincter injuries. Furthermore, it provides guidance on primary repair and immediate postpartum management for obstetrical anal sphincter tears in order to minimize further negative sequelae.
All patients having a vaginal delivery and those who have sustained an obstetrical anal sphincter injury.
Certain preventive strategies have been associated with lower rates of obstetrical anal sphincter injuries (e.g., fetal head flexion and control, appropriate use of mediolateral episiotomy). Management strategies, including appropriate diagnosis and repair of obstetrical anal sphincter injuries, antibiotic prophylaxis, and bowel and bladder function management can decrease associated short- and long-term complications.
BENEFITS, HARMS, AND COSTS: Implementation of the recommendations in this guideline may increase detection, prevention, and appropriate management of obstetrical anal injuries, thus limiting the future burden associated with these injuries. Implementation of the recommended classification of obstetrical anal sphincter injuries will improve national and international research efforts.
Published literature was retrieved through searches of PubMed, Ovid, Medline, Embase, Scopus, and the Cochrane Library from September 1, 2014, through November 30, 2023, using appropriate MeSH terms (delivery, obstetrics, obstetric surgical procedures, obstetric labor complications, anal canal, episiotomy) and keywords (OASIS, obstetrical anal sphincter injury, anal injury, anal sphincter, vaginal delivery, suture, fecal incontinence, anal incontinence, overlap repair, end-to-end repair, bladder protocol, analgesia). Results were restricted to systematic reviews, meta-analyses, randomized controlled trials/controlled clinical trials, observational studies, and clinical practice guidelines. Results were limited to English- or French-language materials. Evidence was supplemented with references from the 2015 Society of Obstetricians and Gynaecologists of Canada guideline no. 330.
The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations).
Obstetrical care providers.
Updated Canadian guideline on recognition, prevention and management of obstetrical anal sphincter injuries (OASIS).
RECOMMENDATIONS.
本指南旨在促进对产科肛门括约肌损伤的识别及预防策略。此外，它还为产科肛门括约肌撕裂的一期修复及产后即刻处理提供指导，以尽量减少进一步的不良后果。
所有经阴道分娩的患者以及发生产科肛门括约肌损伤的患者。
某些预防策略与较低的产科肛门括约肌损伤发生率相关（例如，胎头俯屈与控制、会阴侧切术的合理使用）。管理策略，包括产科肛门括约肌损伤的恰当诊断与修复、抗生素预防以及肠道和膀胱功能管理，可减少相关的短期和长期并发症。
益处、危害与成本：实施本指南中的建议可能会提高对产科肛门损伤的检测、预防及恰当管理，从而减轻这些损伤未来带来的负担。实施推荐的产科肛门括约肌损伤分类将改善国内和国际的研究工作。
通过检索PubMed、Ovid、Medline、Embase、Scopus和Cochrane图书馆，从2014年9月1日至2023年11月30日获取已发表的文献，使用适当的医学主题词（分娩、产科学、产科手术、产科分娩并发症、肛管、会阴侧切术）和关键词（产科肛门括约肌损伤、肛门损伤、肛门括约肌、阴道分娩、缝合、大便失禁、肛门失禁、重叠修复、端端修复、膀胱处理方案、镇痛）。结果仅限于系统评价、荟萃分析、随机对照试验/对照临床试验、观察性研究和临床实践指南。结果仅限于英语或法语材料。证据以2015年加拿大妇产科学会第330号指南的参考文献作为补充。
作者使用推荐分级评估、制定和评价（GRADE）方法对证据质量和推荐强度进行评级。见在线附录A（表A1为定义，表A2为强推荐和有条件推荐的解释）。
产科护理人员。
更新后的加拿大产科肛门括约肌损伤（OASIS）识别、预防和管理指南。
推荐意见。
