Obstetric anal sphincter injuries: Review of recent medico-legal aspects

Abstract

Obstetric anal sphincter injuries (OASIS) are the leading cause of anal incontinence in women and are increasing in incidence. The NHSLA 10-year report on maternity claims identified perineal trauma as being the fourth highest indication for claims, with £31 million in legal pay-outs alone. OASIS could be classed as moderate to severe harm in the National Patient Safety Agency (NPSA) stratifi cation (http://www.npsa.nhs.uk/corporate/news/npsareleases-organisation-patient-safety-incident-reportingdata-england/). There are also initiatives to declare it as a patient safety indicator (www.oecd.org/dataoecd/53/ 26/33878001.pdf). More recently, in Davison v Leitch EWHC 3092, a High Court Judge awarded £1.6 million in damages where the breach of the duty of care included failure to comply with national guidelines (NICE, Royal College of Obstetricians and Gynaecologists (RCOG)) to perform an episiotomy which was adequately angled away from the anal sphincter muscles (mediolateral episiotomy). Other findings included a failure adequately to diagnose the injury, inadequate postoperative care, failure to inform the patient and her general practitioner about the condition and inappropriate use of forceps. Given the potentially devastating physical injuries suffered by the patients and the financial loss to the NHS when OASIS arises, this is an issue which demands careful attention from the medico-legal community.