Rahman Sara, Wallace Shannon L
Division of Urogynecology & Pelvic Reconstructive Surgery, Obstetrics & Gynecology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195-0001, USA.
Division of Urogynecology & Pelvic Floor Disorders, Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA.
Int Urogynecol J. 2025 Jun 25. doi: 10.1007/s00192-025-06201-2.
Patients with obstetric anal sphincter injury (OASI) are at increased risk for postpartum complications.
To measure the incidence of surgical treatments within 1 year of delivery among patients with OASI. Secondary outcomes included identifying the indications for surgical retreatments of OASI complications and characterizing the procedures performed.
This was a retrospective cohort study of patients with OASI seen at a tertiary referral center between October 2017 and February 2023.
A total of 623 patients sustained an OASI during the study period. The mean age was 30.9 years (SD 4.5). Most patients were White non-Hispanic (n = 454, 72.8%), with a mean body mass index (BMI) of 30.6 (SD 5.5). The mean gestational age at delivery was 39.1 weeks (SD 1.4). Nearly half underwent operative deliveries (n = 287, 46.1%), and the majority had a third degree OASI (n = 526, 84.4%). Thirteen patients (2.1%) underwent surgical treatment within 1 year of delivery. Fourteen total procedures were performed, as one patient required two surgeries. The most common indication for surgery was persistent pain or tenderness followed by dyspareunia, wound breakdown, rectovaginal fistula, and post-coital bleeding. The most frequently performed procedures included revision or excision of scar tissue, perineorrhaphy, excision of granulation tissue, revision of perineal wound disruption/breakdown, and transvaginal rectovaginal fistula repair. Urogynecologists performed 11 of the 14 procedures.
In this cohort, surgical intervention within 1 year of an OASI was uncommon. Postpartum patients with OASI should be screened for persistent pain and tenderness, dyspareunia, wound breakdown, rectovaginal fistula, and post-coital bleeding, as these symptoms may warrant surgical evaluation and treatment.
产科肛门括约肌损伤（OASI）患者产后并发症风险增加。
测量OASI患者分娩后1年内手术治疗的发生率。次要结局包括确定OASI并发症手术再治疗的指征并描述所实施的手术。
这是一项对2017年10月至2023年2月在一家三级转诊中心就诊的OASI患者进行的回顾性队列研究。
在研究期间，共有623例患者发生OASI。平均年龄为30.9岁（标准差4.5）。大多数患者为非西班牙裔白人（n = 454，72.8%），平均体重指数（BMI）为30.6（标准差5.5）。分娩时的平均孕周为39.1周（标准差1.4）。近一半患者接受了手术分娩（n = 287，46.1%），大多数为三度OASI（n = 526，84.4%）。13例患者（2.1%）在分娩后1年内接受了手术治疗。共实施了14例手术，因为1例患者需要进行两次手术。最常见的手术指征是持续疼痛或压痛，其次是性交困难、伤口裂开、直肠阴道瘘和性交后出血。最常实施的手术包括瘢痕组织的修复或切除、会阴修补术、肉芽组织切除、会阴伤口裂开/破损修复以及经阴道直肠阴道瘘修补术。14例手术中有11例由泌尿妇科医生实施。
在该队列中，OASI后1年内进行手术干预并不常见。应筛查产后OASI患者是否存在持续疼痛和压痛、性交困难、伤口裂开、直肠阴道瘘和性交后出血，因为这些症状可能需要进行手术评估和治疗。
