Evidence map›Paper›PMID 31230097›Full record

ArticleInternational urogynecology journal2020

Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study.

Joanna Caroline D'Souza, Ash Monga, Douglas G Tincello, Abdul H Sultan, Ranee Thakar, Timothy C Hillard, Stephanie Grigsby, Ayisha Kibria, Clare F Jordan, Christopher Ashmore

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Article in International urogynecology journal, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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  9. GP's role in supporting women with anal incontinence after childbirth injury: a qualitative study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Joanna Caroline D'SouzaFaculty of Medicine, University of Southampton, University Hospitals NHS Foundation Trust, Southampton, UK. jcdsouza3@gmail.com.ORCID 0000-0003-1643-4658
Ash MongaPrincess Anne Hospital, University Hospitals NHS Foundation Trust, Southampton, UK.
Douglas G TincelloDepartment of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK.
Abdul H SultanCroydon Health Services NHS Trust, Croydon, UK.
Ranee ThakarCroydon Health Services NHS Trust, Croydon, UK.
Timothy C HillardPoole Hospital NHS Foundation Trust, Poole, UK.
Stephanie GrigsbyPoole Hospital NHS Foundation Trust, Poole, UK.
Ayisha KibriaUniversity Hospitals of Leicester NHS Trust, Leicester, UK.
Clare F JordanUniversity Hospitals of Leicester NHS Trust, Leicester, UK.
Christopher AshmoreUniversity Hospitals of Leicester NHS Trust, Leicester, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introduction and hypothesisWomen with a history of obstetric anal sphincter injury (OASI) are at increased risk of recurrence (rOASI) at subsequent delivery; however, evidence regarding the factors influencing this risk is limited. Furthermore, little is known about what factors influence the decision to alternatively deliver by elective caesarean section (ELLSCS).

methodsRetrospective univariate and multivariate logistic regression analysis of prospectively collected data from four NHS electronic maternity databases including primiparous women sustaining OASIS during a singleton, term, cephalic, vaginal delivery between 2004 and 2015, who had a subsequent delivery.

resultsTwo thousand two hundred seventy-two women met the criteria; 10.2% delivering vaginally had a repeat OASI and 59.4% had a second-degree tear. Women having an ELLSCS were more likely to be Caucasian, older, have previously had an operative vaginal delivery (OVD) and have a more severe degree of OASI. Positive predictors for rOASI were increased birth weight and maternal age at both index and subsequent deliveries, a more severe degree of initial OASI and Asian ethnicity. The overall mediolateral episiotomy (MLE) rate was 15.6%; 77.2% of those who had an episiotomy sustained no spontaneous perineal trauma. Only 4.4% of women with a rOASI had an MLE, whilst the MLE rate was 16.9% in those without a recurrence (p < 0.001). MLE decreased the risk of rOASI by 80%. Birth weight > 4 kg increased the risk 2.5 fold.

conclusionsWomen with previous OASIS are at an increased risk of recurrence. A more liberal use of MLE during subsequent vaginal delivery could significantly reduce the risk of recurrence.

Indexed as

Anal CanalObstetric Labor ComplicationsCesarean SectionDelivery, ObstetricEpisiotomyFemaleHumansPregnancyRetrospective StudiesRisk FactorsMediolateral episiotomyObstetric anal sphincter injuriesPerineal traumaRecurrent obstetric anal sphincter injury

Identifiers

PMID31230097
PMCPMC7093337

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.