Publication: A10-year review on the outcome of primary repair of obstetric anal sphincter injury in Hospital Universiti Sains Malaysia
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Date
2022
Authors
Haiyee, Syafnaz Abdul
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Abstract
Background Obstetric anal sphincter injuries (OASIS) are a major factor in the development of anal incontinence and can have a devastating effect on the physical and emotional well-being of affected women. It is a grave complication as it can affect the quality of life as well as it can give an impact on subsequent pregnancies. Sound operative repair is essential, yet between 14 and 61% patients with obstetric anal sphincter injuries report incontinence symptoms. Objective To determine the proportion of anal incontinence following primary repair and to identify the risk factor associated with anal incontinence after six months post-primary repair in Hospital USM from 1st December 2010 until 31st November 2020. Methodology: This was a retrospective observational study involving all women who underwent primary repair following obstetrics anal sphincter injury in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan. A total of 271 cases of OASIS were encountered and at six months its repair outcome was analyzed. Patients were assessed regarding the anal incontinence symptoms and the risk factors contributing to OASIS were also analyzed. The degree of perineal injury and other related information were retrieved from the case notes. Data were analysed using univariate analysis to look for the association between risk factors and the outcome of primary repair. Results In this research, there were 271 cases of OASIS during the 10 years study period. Only 5 cases ( 1.8%) of anal incontinence cases were encountered. There was a significant association between grading of OASIS and the occurrence of anal incontinence on descriptive statistics. 80 women sustained a Grade 3a tear (29.6% ), 127 women had a Grade 3b tear ( 47% ), 32 women had a Grade 3c ( 11.9% ) and 31 women had a fourth-degree tear (11.5%) However, this association was not significant on multiple logistic regression. There was no association noted between other variables and anal incontinence Conclusion : Anal incontinence complicates 1.8% (5 cases) of OASIS during the 10 year study period. There was no significant association between anal incontinence and risk factors.