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BMC Health Services Research

, 2:9

First Online: 13 May 2002Received: 27 September 2001Accepted: 13 May 2002DOI: 10.1186-1472-6963-2-9

Cite this article as: Fernando, R.J., Sultan, A.H., Radley, S. et al. BMC Health Serv Res 2002 2: 9. doi:10.1186-1472-6963-2-9


BackgroundWe aim to establish the evidence base for the recognition and management of obstetric anal sphincter injury OASI and to compare this with current practice amongst UK obstetricians and coloproctologists.

MethodsA systematic review of the literature and a postal questionnaire survey of consultant obstetricians, trainee obstetricians and consultant coloproctologists was carried out.

ResultsWe found a wide variation in experience of repairing acute anal sphincter injury. The group with largest experience were consultant obstetricians 46.5% undertaking ≥ 5 repairs-year, whilst only 10% of responding colorectal surgeons had similar levels of experience p < 0.001. There was extensive misunderstanding in terms of the definition of obstetric anal sphincter injuries. Overall, trainees had a greater knowledge of the correct classification p < 0.01. Observational studies suggest that a new -overlap- repair using PDS sutures with antibiotic cover gives better functional results. However, our literature search found only one randomised controlled trial RCT on the technique of repair of OASI, which showed no difference in incidence of anal incontinence at three months. Despite this, there was a wide variation in practice, with 33750% consultants, 82 55% trainees and 80 89% coloproctologists already using the -overlap- method for repair of a torn EAS p < 0.001. Although over 50% of colorectal surgeons would undertake long-term follow-up of their patients, this was the practice of less than 10% of obstetricians p < 0.001. Whilst over 70% of coloproctologists would recommend an elective caesarean section in a subsequent pregnancy, only 22% of obstetric consultants and 14% of trainees p < 0.001.

ConclusionAn agreed classification of OASI, development of national guidelines, formalised training, multidisciplinary management and further definitive research is strongly recommended.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-2-9 contains supplementary material, which is available to authorized users.

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Autor: Ruwan J Fernando - Abdul H Sultan - Simon Radley - Peter W Jones - Richard B Johanson


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