This is a retrospective cohort study of 380 women diagnosed with OASI, following singleton vaginal deliveries, during a 10-year period (January 2011 to December 2020). The study was conducted in a tertiary university-affiliated hospital (Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv University, Israel) with more than 12,000 deliveries per year. The study protocol was reviewed and approved by the institutional ethical review board. Asian ethnicity was defined as having been born in one of the following countries: Cambodia, China, Mongolia, Nepal, Philippines, Japan, Singapore, Sri Lanka, South Korea, Thailand, or Vietnam.
Demographic, maternal, obstetric, and neonatal parameters were compared between OASI cases diagnosed among local Caucasian women versus immigrant women of Asian ethnicity. All data were retrieved from a computerized database using the International Classification of Diseases 9th Revision codes for perineal lacerations. Exclusion criteria composed of age < 18 years, stillbirths, breech presentation, or ethnicity other than Caucasian or Asian. Comorbidities, use of drugs, alcohol, smoking, gestational diabetes status, and weight gain during pregnancy were among the maternal characteristics examined. Body mass index (BMI) was calculated from height and weight measurements prior to pregnancy or during the first trimester. Obstetric-related details included parity, gestational age, intrapartum fever, length of the first and second stages of labor, usage of oxytocin for the induction or augmentation of labor, fetal presentation and position, episiotomy, instrumental-assisted vaginal delivery, and incidence of shoulder dystociaNeonatal characteristics included gender, Apgar scores, and birth weights. Maternal complications included: OASI, blood loss, and the need for blood-product transfusions.
At our institution, midwives handle uncomplicated deliveries. Instrumental-assisted deliveries are performed only by obstetricians using a vacuum device. Vacuum extraction is performed when the fetal head is stationed below the level of the ischial spines (at +1 or more). For nulliparous women, a prolonged second stage is defined as two hours or longer, and for parous women, one hour or longer, with an additional one hour if epidural analgesia is employed. A selective episiotomy policy is employed, and only mediolateral episiotomies are performed. Perineal protection is always undertaken during delivery, either spontaneous or instrumental. Diagnosis of the severity of obstetric tears is performed by obstetricians. According to the American College of Obstetrics and Gynecology (ACOG) guidelines, a third-degree perineal tear involves the anal sphincter muscle, while a fourth-degree perineal tear extends through the anal sphincter and into the rectal mucosa [15 (link)]. Repair of OASI is performed only by senior Obstetricians who have completed a training course for the diagnosis and repair of OASI. Repair of a fourth-degree OASI is performed by colorectal specialists.
Women who endure OASI are evaluated at the urogynecological clinic at 1, 6, and 12 months after delivery. Pelvic floor muscle training is strongly recommended during the puerperium period. Transrectal ultrasound (TRUS) and manometry are performed during the first year after delivery in order to assess the integrity and function of the anal sphincter.
Demographic, maternal, obstetric, and neonatal parameters were compared between OASI cases diagnosed among local Caucasian women versus immigrant women of Asian ethnicity. All data were retrieved from a computerized database using the International Classification of Diseases 9th Revision codes for perineal lacerations. Exclusion criteria composed of age < 18 years, stillbirths, breech presentation, or ethnicity other than Caucasian or Asian. Comorbidities, use of drugs, alcohol, smoking, gestational diabetes status, and weight gain during pregnancy were among the maternal characteristics examined. Body mass index (BMI) was calculated from height and weight measurements prior to pregnancy or during the first trimester. Obstetric-related details included parity, gestational age, intrapartum fever, length of the first and second stages of labor, usage of oxytocin for the induction or augmentation of labor, fetal presentation and position, episiotomy, instrumental-assisted vaginal delivery, and incidence of shoulder dystociaNeonatal characteristics included gender, Apgar scores, and birth weights. Maternal complications included: OASI, blood loss, and the need for blood-product transfusions.
At our institution, midwives handle uncomplicated deliveries. Instrumental-assisted deliveries are performed only by obstetricians using a vacuum device. Vacuum extraction is performed when the fetal head is stationed below the level of the ischial spines (at +1 or more). For nulliparous women, a prolonged second stage is defined as two hours or longer, and for parous women, one hour or longer, with an additional one hour if epidural analgesia is employed. A selective episiotomy policy is employed, and only mediolateral episiotomies are performed. Perineal protection is always undertaken during delivery, either spontaneous or instrumental. Diagnosis of the severity of obstetric tears is performed by obstetricians. According to the American College of Obstetrics and Gynecology (ACOG) guidelines, a third-degree perineal tear involves the anal sphincter muscle, while a fourth-degree perineal tear extends through the anal sphincter and into the rectal mucosa [15 (link)]. Repair of OASI is performed only by senior Obstetricians who have completed a training course for the diagnosis and repair of OASI. Repair of a fourth-degree OASI is performed by colorectal specialists.
Women who endure OASI are evaluated at the urogynecological clinic at 1, 6, and 12 months after delivery. Pelvic floor muscle training is strongly recommended during the puerperium period. Transrectal ultrasound (TRUS) and manometry are performed during the first year after delivery in order to assess the integrity and function of the anal sphincter.
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