Observational studyInternational urogynecology journal2021
Effect of a subsequent pregnancy on anal sphincter integrity and function after obstetric anal sphincter injury (OASI).
Observational study in International urogynecology journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
What it found
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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.
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.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 24 citations in OpenAlex.
- Prevalence of fecal incontinence after childbirth in Turkey: systematic review and meta-analysis.Irish journal of medical science · 2025Pooled it
- Caesarean section and anal incontinence in women after obstetric anal sphincter injury: A systematic review and meta-analysis.BJOG : an international journal of obstetrics and gynaecology · 2025Pooled it
- Perineal Membrane Structural Changes: An Unstudied Aspect of Prolapse.International urogynecology journal · 2026Article
- IUGA International Guidelines on Obstetric Anal Sphincter Injuries.International urogynecology journal · 2026Article
- The Use of Transperineal and Endoanal Ultrasound in Diagnosis and Management of Obstetric Anal Sphincter Injuries (OASIs): A Narrative Review from a Gynecologic Perspective.Diagnostics (Basel, Switzerland) · 2026Review
- Role of Ultrasound in the Evaluation of Women with Obstetric Anal Sphincter Injuries: Narrative Review.International urogynecology journal · 2026Review
- Perineal structural changes on 3-dimensional endovaginal ultrasound 6 months after difficult vaginal birth: the Hourglass-Band pattern and how it relates to levator ani avulsion and hiatus size.American journal of obstetrics and gynecology · 2026Article
- Sonographic postpartum anal sphincter defects and the association with pelvic floor pain and dyspareunia.Acta obstetricia et gynecologica Scandinavica · 2023Article
- Association of delivery mode and number of pregnancies with anorectal manometry data in patients with postpartum constipation.BMC pregnancy and childbirth · 2023Article
- Comparison of diagnostic criteria for significant anal sphincter defects between endoanal and transperineal ultrasound.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2022Article
- Under-classified obstetric anal sphincter injuries.International urogynecology journal · 2022Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introduction and hypothesisEndoanal ultrasound (EAUS) and anal manometry are used in the assessment women with a history of obstetric anal sphincter injury (OASI), both postpartum and in a subsequent pregnancy, to aid counselling regarding mode of delivery (MOD).
methodsA prospective observational study between 2012 to 2020 was completed. Women were reviewed 3 months postpartum following OASI and in the second half of a subsequent pregnancy. Anorectal symptoms were measured using the validated St Mark's Incontinence Score (SMIS: asymptomatic to mild symptoms = ≤ 4). Anal manometry (incremental maximum squeeze pressure [iMSP: normal = > 20 mmHg]) and EAUS (abnormal = sphincter defect > 1 h in size) were performed.
resultsOne hundred forty-six women were identified and 67.8% had an anal sphincter defect ≤ 1 h in size postnatally. In those with a defect ≤ 1 h, postpartum mean iMSP and SMIS significantly improved in a subsequent pregnancy (p = 0.04 and p = 0.01, respectively). In women with a defect > 1 h, there was no significant difference between the mean iMSP or SMIS score postnatally compared to a subsequent pregnancy. At both time points, significantly more women had an anal sphincter defect ≤ 1 h and SMIS of ≤ 4 (p = 0.001 and p < 0.001 respectively) compared to those with a defect < 1 h. In addition, significantly more women had an anal sphincter defect ≤ 1 h and iMSP ≥ 20 mmHg (p < 0.001). Overall, out of the 146 women included in this study, 76 (52.1%) with a defect ≤ 1 h also had an iMSP ≥ 20 mmHg and SMIS ≤ 4 at 3 months postpartum.
conclusionsWomen who remain asymptomatic with normal anal manometry and no abnormal sphincter defects on EAUS postnatally do not need to have these investigations repeated in a subsequent pregnancy and can be recommended to have a vaginal delivery. If our protocol was modified, over half of the women in this study could have had their MOD recommendation made in the postnatal period alone.
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