ArticleBJOG : an international journal of obstetrics and gynaecology2025
Clinical Grade of Obstetric Anal Sphincter Injuries and Prediction of Mode of Birth Recommendations: A 20-Year Retrospective Analysis.
Article in BJOG : an international journal of obstetrics and gynaecology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Perineal Trauma and Obstetric Anal Sphincter Injuries (OASIs) in the United Kingdom: National Trends and Practice Changes Over a Decade.International urogynecology journal · 2026Article
- IUGA International Guidelines on Obstetric Anal Sphincter Injuries.International urogynecology journal · 2026Article
- Female pelvic floor protection-Where do we have to go?Acta obstetricia et gynecologica Scandinavica · 2026Review
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3 authors.
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Abstract
objectiveTo determine whether assessment of symptoms and clinical grade of obstetric anal sphincter injuries (OASIs) is predictive of subsequent endoanal ultrasound (EAUS) and anal manometry (AM) findings to guide mode of birth recommendations.
designTwenty-year retrospective analysis.
settingTertiary urogynaecology unit. POPULATION OR SAMPLE: Women (n = 607) with a history of OASI in the second half of a subsequent pregnancy, 2002-2022.
methodsA St Mark's Incontinence Score (SMIS), AM and EAUS were completed. An elective caesarean section (ELCS) was recommended if there was an external anal sphincter (EAS) defect and an incremental maximum squeeze pressure (IMSP) < 20 mmHg.
main outcome measuresAccuracy, sensitivity, specificity, negative and positive predictive values (NPV and PPV) with 95% CI were calculated for the assessment of anorectal symptoms and clinical grade of tear relative to EAUS and AM findings.
resultsAccuracy of symptom assessment and clinical grade of tear in determining those with an EAS defect and IMSP < 20 was 75.4% (95% CI 69.3%), 69.6% (95% CI 63.8%-75.0%), 62.7% (95% CI 50.0-74.2) and 43.6% (95% CI 27.8%-60.4%) with 3a, 3b, 3c and fourth degree tears, respectively. 3a tears had the highest NPV for EAS defect and IMSP < 20 (100.0% [95% CI 97.9-100.0]), EAS defect alone (97.1% [95% CI 94.7%-98.4%]) and IMSP < 20 alone (93.5% [95% CI 90.1-82.1]).
conclusionsSymptom assessment and clinical grade of OASI cannot be used solely to guide mode of delivery recommendations in a subsequent birth. Absence of symptoms in women with 3a tears has a high NPV, meaning these women can be recommended a vaginal birth.
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