Obstetric Anal Sphincter Injury: Counseling for Future Deliveries.

This article provides a comprehensive review of counseling in subsequent deliveries for patients with a history of obstetric anal sphincter injury (OASI). Patients with prior OASI are at increased risk for recurrent OASI compared to other multiparous patients, however, the rates of primary and recurrent OASI are similar at 4.4-11% and 3.7-13.4%, respectively. Subsequent delivery care includes a review of the index delivery course, acute postpartum complications, OASI sequelae, and patient risk factors. Counseling should include understanding the patient's values and preferences, a risk-benefit discussion of delivery modalities, and an appropriate recommendation for the subsequent mode of delivery. There are no absolute contraindications to subsequent vaginal delivery, and newer data suggests appropriate mode of delivery selection results in stable pelvic floor functional status. This highlights the importance of counseling for shared decision-making for future delivery planning.