Transcript Document

Postpartum Symptom Review of Obstetric- Associated Anal Sphincter
Injury (OASIS) comparing Normal Vaginal Delivery (NVD) with Assisted
Vaginal Delivery.
Wiseman S
1,
O’Sullivan S
2,
O’Reilly B
2,
Barry
3
L
INTRODUCTION
We compared the severity of symptoms in women with OASIS from (NVD), forceps (F),vacuum (V) and vacuum & forceps (V&F) and
grouped them accordingly. Symptoms were evaluated with a telephone questionnaire at 6 weeks postpartum. Women who were
asymptomatic were not reviewed further. Symptomatic women were assessed at 12 weeks at their first physiotherapy appointment.
Symptoms declared at 6 weeks were compared to the symptoms at 12 weeks. In all of the groups, patients presented with more than one
symptom at 6weeks and 12 weeks. A total of 106 OASIS injuries from June 2013 to June 2014 were reviewed in this study.
METHOD
Questions from the Pelvic Floor Distress Inventory Questionnaire-20 and the Queensland’s Pelvic Floor Questionnaire were used to look at
bladder, bowel and pelvic floor pain symptoms as well as sexual function at 6 and 12 weeks postpartum.
Symptoms specific to physiotherapy including pelvic girdle and coccyx pain were also assessed at 12 weeks at their first physiotherapy review.
RESULTS
TELEPHONE REVIEW AT 6 WEEKS POSTPARTUM
OASIS Groups
Total
(n= 106)
Asymptomatic at 6 weeks
Symptomatic at 6 weeks
No. of 4th degree
tears
4th degree tears
asymptomatic at 6 weeks
Normal Vaginal Delivery
(NVD)
45
24 (53.3%)
21(46.7%)
2 (4.4%)
1 (4.1%)
Vacuum & Forceps (V&F)
26
2 (7.7%)
24 (92.3%)
6 (23.1%)
0
Forceps (F)
12
3 (25%)
9 (75%)
1 (8.3%)
0
Vacuum (V)
23
8 ( 34.8%)
15 (65.2%)
0
0
:
SYMPTOMATIC OASIS GROUPS AT THE 6 WEEKS TELEPHONE REVIEW
Symptoms presented per
group at 6 weeks
OASIS (NVD)
( n= 21) 46.7%
OASIS (V&F)
( n= 24) 92.3%
OASIS (F)
(n=9) 75%
OASIS (V)
(n=15) 65.2%
Pain
12 (57.1%)
10 (47.6%)
1 (4.8%)
7 (33.3%)
8 (38.1%)
18
17
5
16
11
(75%)
(70.8%)
(20.8%)
(66.7%)
(45.8%)
6 (66.7%)
5 (55.6%)
1 (11.1%)
3 (33.3%)
3 ( 33.3%)
8 (53.3%)
8 (53.3%)
3 (20%)
7 ( 46.7%)
8 (53.3%)
Reduced flatus control
8 (38.1%)
15 (62.5%)
7 (77.8%)
11 (73.3%)
Resumed intercourse at 6
weeks postpartum
0
0
0
0
Stress urinary incontinence
Faecal incontinence
Faecal urgency
Pain/ difficulty opening
bowels
SYMPTOMATIC OASIS GROUPS AT 12 WEEKS POST PARTUM, FIRST PHYSIOTHERAPY REVIEW
Symptoms presented at
physiotherapy, 12 weeks
postpartum
OASIS (NVD)
(n=21) 46.7%
OASIS ( V&F)
(n=24) 92.3%
OASIS (F)
(n=9) 75%
OASIS (V)
(n=15) 65.2%
Changes in symptoms from
6 weeks
0
0
0
0
Pelvic organ prolapse =/>
stage 2
Pelvic Girdle/ coccyx pain
0
2 (8.3%)
1 ( 11.1%)
0
5 (23.8%)
3 (12.5%)
0
2 (13.3%)
Attempted intercourse at 12
weeks
1(4.7%)
1(4.1%)
2(22.2%)
0
Reported dyspareunia
1(4.7%)
1(4.1%)
2(22.2%)
0
CONCLUSION
We found that at 6 weeks, women with OASIS from vacuum & forceps deliveries had significantly greater symptoms when compared to
women who were delivered using single instrument or with NVD. The NVD group had the highest number of asymptomatic women at
follow up. We found that the telephone assessment at 6 weeks allowed us to prioritise all symptomatic women. 6 weeks physiotherapy
review is appropriate as no further natural resolution of symptoms were seen in any group between the 6 to 12 weeks period. We
recommend prioritising patients with OASIS(V&F) for physiotherapy as they are in the highest risk group due to greater severity in
symptoms. A further study to review the outcome of the groups at a year post partum, on completion of physiotherapy treatment will be
Contact Details
done.
Wiseman S (MISCP,POGP)
REFERENCES
1.Aura Pyykonen, Mika Gissler, Mija Jacobson, The rate of obstetric anal sphincter injuries in Finnish obstetric units as a patient safety indicator.
European Journal of Obstetrics & Gynecology and Reproductive Biology 2013, 1, 169, pages 33 – 38.
2.Carin Boij, Leif Mettheisen, Margareta Krantz, Roland Boij, Sexual function and well being after obstetric anal sphincter injury. British Journal of
Midwifery, Nov 2007, Vol 15, No.11.
Senior Physiotherapist in Women’s Health &
Continence
Cork University Maternity Hospital, Ireland.
Email:[email protected]