Factors that influence patient preference for mode of delivery following an obstetric anal sphincter injury

Published:December 08, 2017DOI:



      A common indication for elective caesarean is previous obstetric anal sphincter injury (OASI). This study aims to identify factors that influence womens’ preferences regarding mode of delivery (MoD) in a subsequent pregnancy following an OASI.


      100 consecutive women who sustained an OASI completed a questionnaire when attending postnatal follow up at a perineal trauma clinic. They also completed ePAQ-PF to assess pelvic floor symptoms. Data was collated and percentages generated for each response. A chi-squared calculation was used for preferred MoD.


      In total, 75 women were Primiparous and 25 Multiparous. 20% of women were advised to have a caesarean, with the remainder advised either a vaginal delivery or further investigations. 79% of women had a 3a/3b tear and 21% of women had a 3c/4th degree OASI. Based on women’s preferences, those who sustained a 3c/4th degree tear were more likely to opt for CS than a 3a/b degree tear (p < 0.001). Bowel symptoms per se did not correlate with choice of MoD in either group. In women with 3c/4th OASI vaginal or sexual symptoms did not impact on the decision regarding choice of delivery but in women who sustained a 3a/b tear the impact on sexual function appears to be the commonest symptom in those who wished a caesarean section.


      Women with 3c/4th OASI are more likely to accept a planned CS. Bowel symptoms appear to have little impact on this but in women with lower grade tears sexual symptoms have the greatest impact on preferred MoD.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      1. World health organisation statement on caesarean section rates. 1-4-2015.
        2015 (Ref Type: Generic)
      2. HES data 2013/14.2016.
        2016 ( Ref Type: Generic)
        • RCOG
        Third- and fourth-degree perineal tears, management No 29.
        2015 (Green Top Guideline No 29 . 12-6-2015. Ref Type: Generic)
        • Jones G.L.
        • Radley S.C.
        • Lumb J.
        • Jha S.
        Electronic pelvic floor symptoms assessment: tests of data quality of ePAQ-PF.
        Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 1337-1347
        • Radley S.C.
        • Jones G.L.
        • Tanguy E.A.
        • Stevens V.G.
        • Nelson C.
        • Mathers N.J.
        Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic pelvic floor assessment questionnaire in primary and secondary care.
        BJOG. 2006; 113: 231-238
        • Dua A.
        • Jones G.
        • Wood H.
        • Sidhu H.
        Understanding women's experiences of electronic interviewing during the clinical episode in urogynaecology: a qualitative study.
        Int Urogynecol J. 2013; 24: 1969-1975
        • Ampt A.J.
        • Roberts C.L.
        • Morris J.M.
        • Ford J.B.
        The impact of first birth obstetric anal sphincter injury on the subsequent birth: a population-based linkage study.
        BMC Pregnancy Childbirth. 2015; 13: 31
        • Ali A.
        • Glennon K.
        • Kirkham C.
        • Yousif S.
        • Eogan M.
        Delivery outcomes and events in subsequent pregnancies after previous anal sphincter injury.
        Eur J Obstet Gynecol Reprod Biol. 2014; 174: 51-53
        • Priddis H.
        • Dahlen H.G.
        • Schmied V.
        • Sneddon A.
        • Kettle C.
        • Brown C.
        • et al.
        Risk of recurrene, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000 and 2008: a population based data linkage study.
        BMC Pregnancy Childbirth. 2013; 8: 89
        • Karmarkar R.
        • Bhide A.
        • Diqesu A.
        • Khullar V.
        • Fernando R.
        Mode of delivery after obstetric anal sphincter injury.
        Eur J Obstet Gynecol Reprod Biol. 2015; 194: 7-10
        • Fitzpatrick M.
        • Cassidy M.
        • Barassaud M.L.
        • Hehir M.P.
        • Hanly A.M.
        • O'Connell P.R.
        • et al.
        Does anal sphincter injury preclude subsequent vaginal delivery?.
        Eur J Obstet Gynecol Reprod Biol. 2016; 198: 30-34
        • Baghestan E.
        • Irgens L.M.
        • Børdahl P.E.
        • Rasmussen S.
        Risk of recurrence and subsequent delivery after obstetric anal sphincter injuries.
        BJOG. 2012; 119: 62-69
        • Mahony R.
        • O'Herlihy C.
        Recent impact of anal sphincter injury on overall Caesarean section incidence.
        Aust N Z J Obstet Gynaecol. 2006; 46: 202-204
        • Jangö H.
        • Langhoff-Roos J.
        • Rosthøj S.
        • Sakse A.
        Mode of delivery after obstetric anal sphincter injury and the risk of long term anal incontinence.
        Am J Obstet Gynecol. 2016; 214 (e1-733. e13): 733
        • Jha S.
        • Parker V.
        Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis.
        Int Urogynecol J. 2016; 27: 849-857
        • Sangalli M.R.
        • Floris L.
        • Faltin D.
        • Weil A.
        Anal incontinence in women with third or fourth degree perineal tears and subsequent vaginal deliveries.
        Aust N Z J Obstet Gynaecol. 2000; 40: 244-248