Evaluation of French practices in the management and the follow-up of obstetric anal sphincter injuries (OASIS)

Objective: The aim was to assess the current management and follow-up of obstetric anal sphincter injuries in maternity wards in France at two levels: the patient's and the care unit level.

Study design: We carried out an evaluation of professional practices in all French maternity hospitals by sending a questionnaire that covered five areas: (i) general information about the hospital, (ii) immediate management of OASIS and postpartum care, (iii) patient follow up, (iv) management of a subsequent pregnancy, and (v) training of health professionals.

Results: During this period, 102 answers (22.4 %) were obtained. Forty-five maternity hospitals (44.1 %) did not have a dedicated protocol for the management and the follow-up of OASIS. In four maternities (4 %), the resident or midwife repaired the anal sphincter alone. Ninety-eight percent of the obstetricians repaired the external anal sphincter using either the end-to-end or overlap techniques. Only two maternities (2 %) used postpartum symptom or quality of life questionnaires after OASIS. In the post-partum, in ten (9.8 %) maternities, patients attended a consultation with an urogynecologist. In this study, 57.8 % patients did not have an anal sphincter ultrasonography prescription in their follow-up even though they had symptoms.

Conclusion: We observed a great heterogeneity in the management of patients with OASIS in French maternity hospitals. National guidelines and regular training of health professionals are required to improve this management.