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Can the risk of obstetric anal sphincter injuries (OASIs) be predicted using a risk-scoring system?

McPherson, KC; Beggs, AD; Sultan, AH; Thakar, R (2014) Can the risk of obstetric anal sphincter injuries (OASIs) be predicted using a risk-scoring system? BMC Res Notes, 7. p. 471. ISSN 1756-0500 https://doi.org/10.1186/1756-0500-7-471
SGUL Authors: Sultan, Abdul Hameed

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Abstract

BACKGROUND: Perineal trauma involving the anal sphincter is an important complication of vaginal delivery. Prediction of anal sphincter injuries may improve the prevention of anal sphincter injuries. Our aim was to construct a risk scoring model to assist in both prediction and prevention of Obstetric Anal Sphincter Injuries (OASIs). We carried out an analysis of factors involved with OASIs, and tested the constructed model on new patient data. METHODS: Data on all vaginal deliveries over a 5 year period (2004-2008) was obtained from the electronic maternity record system of one institution in the UK. All risk factors were analysed using logistic regression analysis. Odds ratios for independent variables were then used to construct a risk scoring algorithm. This algorithm was then tested on subsequent vaginal deliveries from the same institution to predict the incidence of OASIs. RESULTS: Data on 16,920 births were analysed. OASIs occurred in 616 (3.6%) of all vaginal deliveries between 2004 and 2008. Significant (p < 0.05) variables that increased the risk of OASIs on multivariate analysis were: African-Caribbean descent, water immersion in labour, water birth, ventouse delivery, forceps delivery. The following variables remained independently significant in decreasing the risk of OASIs: South Asian descent, vaginal multiparity, current smoker, home delivery. The subsequent odds ratios were then used to construct a risk-scoring algorithm that was tested on a separate cohort of patients, showing a sensitivity of 52.7% and specificity of 71.1%. CONCLUSIONS: We have confirmed known risk factors previously associated with OASIs, namely parity, birth weight and use of instrumentation during delivery. We have also identified several previously unknown factors, namely smoking status, ethnicity and water immersion. This paper identifies a risk scoring system that fulfils the criteria of a reasonable predictor of the risk of OASIs. This supersedes current practice where no screening is implemented other than examination at the time of delivery by a single examiner. Further prospective studies are required to assess the clinical impact of this scoring system on the identification and prevention of third degree tears.

Item Type: Article
Additional Information: © 2014 McPherson et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Adult, Anal Canal, Female, Humans, Incidence, Multivariate Analysis, Obstetric Labor Complications, Pregnancy, Prognosis, ROC Curve, Regression Analysis, Research Design, Risk Factors, United Kingdom, Humans, Prognosis, Incidence, Multivariate Analysis, Risk Factors, Regression Analysis, ROC Curve, Pregnancy, Research Design, Adult, Great Britain, Anal Canal, Female, Obstetric Labor Complications, Bioinformatics, 1199 Other Medical And Health Sciences
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Journal or Publication Title: BMC Res Notes
ISSN: 1756-0500
Language: eng
Dates:
DateEvent
24 July 2014Published
21 July 2014Accepted
Publisher License: Creative Commons: Attribution 2.0
Projects:
Project IDFunderFunder ID
102732/Z/13/ZWellcome Trusthttp://dx.doi.org/10.13039/100004440
PubMed ID: 25056485
Go to PubMed abstract
URI: http://sgultest.da.ulcc.ac.uk/id/eprint/109056
Publisher's version: https://doi.org/10.1186/1756-0500-7-471

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