INTRODUCTION We compared the severity of symptoms in women with OASIS from (NVD), forceps (F),vacuum (V) and vacuum & forceps (V&F) and

grouped them accordingly. Symptoms were evaluated with a telephone questionnaire at 6 weeks postpartum. Women who were asymptomatic were not reviewed further. Symptomatic women were assessed at 12 weeks at their first physiotherapy appointment. Symptoms declared at 6 weeks were compared to the symptoms at 12 weeks. In all of the groups, patients presented with more than one symptom at 6weeks and 12 weeks. A total of 106 OASIS injuries from June 2013 to June 2014 were reviewed in this study.

Postpartum Symptom Review of Obstetric- Associated Anal Sphincter Injury (OASIS) comparing Normal Vaginal Delivery (NVD) with Assisted

Vaginal Delivery.

Wiseman S 1, O’Sullivan S 2, O’Reilly B 2, Barry L 3

 

METHODQuestions from the Pelvic Floor Distress Inventory Questionnaire-20 and the Queensland’s Pelvic Floor Questionnaire were used to look atbladder, bowel and pelvic floor pain symptoms as well as sexual function at 6 and 12 weeks postpartum.Symptoms specific to physiotherapy including pelvic girdle and coccyx pain were also assessed at 12 weeks at their first physiotherapy review.

REFERENCES

1.Aura Pyykonen, Mika Gissler, Mija Jacobson, The rate of obstetric anal sphincter injuries in Finnish obstetric units as a patient safety indicator. European Journal of Obstetrics & Gynecology and Reproductive Biology 2013, 1, 169, pages 33 – 38.

2.Carin Boij, Leif Mettheisen, Margareta Krantz, Roland Boij, Sexual function and well being after obstetric anal sphincter injury. British Journal of Midwifery, Nov 2007, Vol 15, No.11.

Contact Details

Wiseman S (MISCP,POGP)

Senior Physiotherapist in Women’s Health &

Continence

Cork University Maternity Hospital, Ireland.

Email:shalini.wiseman@hse.ie

:

CONCLUSION We found that at 6 weeks, women with OASIS from vacuum & forceps deliveries had significantly greater symptoms when compared to women who were delivered using single instrument or with NVD. The NVD group had the highest number of asymptomatic women at follow up. We found that the telephone assessment at 6 weeks allowed us to prioritise all symptomatic women. 6 weeks physiotherapy review is appropriate as no further natural resolution of symptoms were seen in any group between the 6 to 12 weeks period. We recommend prioritising patients with OASIS(V&F) for physiotherapy as they are in the highest risk group due to greater severity in symptoms. A further study to review the outcome of the groups at a year post partum, on completion of physiotherapy treatment will be done.

RESULTS TELEPHONE REVIEW AT 6 WEEKS POSTPARTUM

OASIS Groups Total(n= 106)

Asymptomatic at 6 weeks

Symptomatic at 6 weeks

No. of 4th degree tears

4th degree tears asymptomatic at 6 weeks

Normal Vaginal Delivery (NVD)

45 24 (53.3%) 21(46.7%) 2 (4.4%) 1 (4.1%)

Vacuum & Forceps (V&F)

26 2 (7.7%) 24 (92.3%) 6 (23.1%) 0

Forceps (F) 12 3 (25%) 9 (75%) 1 (8.3%) 0

Vacuum (V) 23 8 ( 34.8%) 15 (65.2%) 0 0

SYMPTOMATIC OASIS GROUPS AT THE 6 WEEKS TELEPHONE REVIEW

Symptoms presented per group at 6 weeks

OASIS (NVD)( n= 21) 46.7%

OASIS (V&F)( n= 24) 92.3%

OASIS (F)(n=9) 75%

OASIS (V)(n=15) 65.2%

Pain 12 (57.1%) 18 (75%) 6 (66.7%) 8 (53.3%)Stress urinary incontinence

10 (47.6%) 17 (70.8%) 5 (55.6%) 8 (53.3%)

Faecal incontinence 1 (4.8%) 5 (20.8%) 1 (11.1%) 3 (20%)Faecal urgency 7 (33.3%) 16 (66.7%) 3 (33.3%) 7 ( 46.7%)Pain/ difficulty opening bowels

8 (38.1%) 11 (45.8%) 3 ( 33.3%) 8 (53.3%)

Reduced flatus control 8 (38.1%) 15 (62.5%) 7 (77.8%) 11 (73.3%)

Resumed intercourse at 6 weeks postpartum

0 0 0 0

SYMPTOMATIC OASIS GROUPS AT 12 WEEKS POST PARTUM, FIRST PHYSIOTHERAPY REVIEW

Symptoms presented at physiotherapy, 12 weeks postpartum

OASIS (NVD)(n=21) 46.7%

OASIS ( V&F)(n=24) 92.3%

OASIS (F)(n=9) 75%

OASIS (V)(n=15) 65.2%

Changes in symptoms from 6 weeks

0 0 0 0

Pelvic organ prolapse =/> stage 2

0 2 (8.3%) 1 ( 11.1%) 0

Pelvic Girdle/ coccyx pain

5 (23.8%) 3 (12.5%) 0 2 (13.3%)

Attempted intercourse at 12 weeks

1(4.7%) 1(4.1%) 2(22.2%) 0

Reported dyspareunia 1(4.7%) 1(4.1%) 2(22.2%) 0