Guideline No. 457: Obstetrical Anal Sphincter Injuries (OASIS) Part I: Prevention, Recognition, and Immediate Management.

Abstract

Objective: The purpose of this guideline is to promote recognition and preventive strategies for obstetrical anal sphincter injuries. Furthermore, it provides guidance on primary repair and immediate postpartum management for obstetrical anal sphincter tears in order to minimize further negative sequelae.

Target population: All patients having a vaginal delivery and those who have sustained an obstetrical anal sphincter injury.

Outcomes: Certain preventive strategies have been associated with lower rates of obstetrical anal sphincter injuries (e.g., fetal head flexion and control, appropriate use of mediolateral episiotomy). Management strategies, including appropriate diagnosis and repair of obstetrical anal sphincter injuries, antibiotic prophylaxis, and bowel and bladder function management can decrease associated short- and long-term complications.

Benefits, harms, and costs: Implementation of the recommendations in this guideline may increase detection, prevention, and appropriate management of obstetrical anal injuries, thus limiting the future burden associated with these injuries. Implementation of the recommended classification of obstetrical anal sphincter injuries will improve national and international research efforts.

Evidence: Published literature was retrieved through searches of PubMed, Ovid, Medline, Embase, Scopus, and the Cochrane Library from September 1, 2014, through November 30, 2023, using appropriate MeSH terms (delivery, obstetrics, obstetric surgical procedures, obstetric labor complications, anal canal, episiotomy) and keywords (OASIS, obstetrical anal sphincter injury, anal injury, anal sphincter, vaginal delivery, suture, fecal incontinence, anal incontinence, overlap repair, end-to-end repair, bladder protocol, analgesia). Results were restricted to systematic reviews, meta-analyses, randomized controlled trials/controlled clinical trials, observational studies, and clinical practice guidelines. Results were limited to English- or French-language materials. Evidence was supplemented with references from the 2015 Society of Obstetricians and Gynaecologists of Canada guideline no. 330.

Validation methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations).