More than half of women with a history of prior obstetric anal sphincter injuries (OASIS) will have another pregnancy. Currently, little is known concerning post-partum perineal symptoms in cases of a subsequent vaginal delivery. The aim of this study was to assess the frequency of perineal functional symptoms following a vaginal delivery after OASIS while comparing them to patients who did not have a subsequent delivery.
Retrospective cohort study between January 2000 and December 2011. A questionnaire was sent by post to all women who sustained an OASIS at the Poitiers University Hospital, France. Perineal functional symptoms and quality of life were assessed using validated self-administered questionnaires: Female Pelvic Floor Questionnaire, Pescatori anal incontinence score, EuroQoL five-dimension score, and pain visual analogue scale.
159 women of 237 contacted (67%) responded to the questionnaire, on average 46 months after the delivery complicated with OASIS. 135 (85%) of women had a 3rd degree laceration and 24% a 4th degree laceration. 99 women (63%) did not have an ensuing delivery since the event (OASIS - No Subsequent Delivery: SD-). 60 women (37%) had a subsequent delivery (OASIS -Subsequent Delivery: SD + ), with 53 (88%) having a vaginal birth. Among these women, 3 (6%) experienced a recurrent OASIS. The mean score for perineal symptoms (FPFQ) was 6.95 in the OASIS-SD (-) group and 7.40 in the OASIS-SD (+) group (p = 0.64). No significant difference in quality of life (EuroQol 5D) was found between the two groups (p = 0.91).
We did not observe a deterioration of perineal functional symptomatology after vaginal delivery in women with known prior OASIS, compared to women who did not have a subsequent delivery. Even if the risk of occurrence of these lesions is higher in women with history of previous OASIS compared to those without perineal injury, it is still comparable to incidence among primiparous women.