Introduction and aim of the study: According with the Green Top Guidelines of the RCOG [
], women with history of obstetric anal sphincter injuries (OASIS) should be advised that physiotherapy could be beneficial.
- Royal College of Obstetricians and Gynaecologists
A third-or fourth-degree tear during birth: Information for you.
The aim of the study was to evaluate the pelvic floor muscles (PFM) strength in the postpartum period of a cohort of women with history of OASIS.
Materials and methods: Voluntary PFM contraction and relaxation was evaluated at 6 months postpartum by vaginal palpation, and scored according to the Modified Oxford Grading Scale (MOS) [
]. Additionally, MOS score was dichotomized in MOS ≤ 2 (underactive/non-functioning) and MOS ≥ 3 (normal).
- Laycock J.
Clinical evaluation of pelvic floor.
in: Schussler B. Laycok J. Norton P. Stanton S. Pelvic floor re-eductio. Principles and practice. Springer-Verlag, London1994: 42-48
Results: 95 females with OASIS identified and repaired intrapartum were included. 56 women (59%) presented an underactive/non-functioning PFM. No statistically significant differences were found between these patients and patients with normal PFM, considering newborn weight or degree of OASIS. A higher percentage of patients who delivered with forceps, showed a weak PFM strength, compared with women who delivered spontaneously (p = 0.04). Furthermore, participants who delivered spontaneously presented a higher MOS than those who delivered with forceps (mean value 2.4 ± 1.3 versus 1.9 ± 1.1, respectively; p = 0.04). Considering age, there was a statistically significant negative correlation between ages and MOS score (p = 0.04, Spearman's correlation). No statistically significant differences were observed in MOS when comparing to different degrees of OASIS. Mean and SD for 3a, 3b, 3c and 4 were 2.0 ± 1.3; 2.3 ± 1.2; 2.6 ± 0.9; 2.0 ± 1.4, respectively.
Interpretation of results: There is no evidence to indicate the optimal method of follow-up after OASIS. A vaginal examination with a digital palpation could be useful before starting a PFM training program. Patients with an underactive or non-functioning PFM would need a different program.
Conclusions: More than a half of patients with history of OASIS showed an underactive or non-functioning PFM at 6 months postpartum. Patients who delivered with forceps presented a lower MOS score.
- A third-or fourth-degree tear during birth: Information for you.RCOG, London2015
- Clinical evaluation of pelvic floor.in: Schussler B. Laycok J. Norton P. Stanton S. Pelvic floor re-eductio. Principles and practice. Springer-Verlag, London1994: 42-48
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