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Factors that influence pregnant women’s decision on mode of delivery after previous obstetric anal sphincter injury

  • Author Footnotes
    1 First co-authors. Equal contribution.
    Brenda F. Narice
    Footnotes
    1 First co-authors. Equal contribution.
    Affiliations
    Academic Unit of Reproductive and Developmental Medicine, the University of Sheffield, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK

    Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
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  • Author Footnotes
    1 First co-authors. Equal contribution.
    Kylie Marks
    Footnotes
    1 First co-authors. Equal contribution.
    Affiliations
    Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
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  • Swati Jha
    Correspondence
    Corresponding author.
    Affiliations
    Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK

    Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
    Search for articles by this author
  • Author Footnotes
    1 First co-authors. Equal contribution.
Published:December 01, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.11.024

      Abstract

      Purpose

      Maternal request for caesarean section (CS) is increasing. One common reason is following a previous obstetric anal sphincter injury (OASI). We aim to understand which factors bear the greatest influence in driving this women’s decision-making process once they are pregnant after having sustained an OASI.

      Methods

      Pregnant women with a previous OASIS who were attending their first antenatal appointment were deemed eligible and were asked to complete two questionnaires on their preferred mode of delivery (MoD) and ongoing pelvic floor symptomatology. Data were analysed with descriptive and inferential statistics using SPSS, and results were presented both quanti- and qualitatively.

      Results

      Data from 63 participants was included in the final analysis. Most women had experienced 3A/3B OASIS (n = 49, 77.78 %), and they were more likely to report bladder pain and difficulties with voiding than those with major tears (p < 0.05). The type of tear did not impact directly on the preferred MoD. However, women still experiencing bladder pain were more likely to request a CS (p < 0.05). Even though all participants who attended a perineal trauma clinic postpartum found it helpful, they reported that ultimately the decision on how to deliver was theirs, and their ideas and concerns played the greatest influence.

      Conclusion

      Pregnant women with ongoing urinary symptoms rather than sexual or bowel dysfunction seem to favour a planned CS, regardless of the severity of their previous tear. Postpartum follow-up in a perineal trauma clinic is extremely valuable but even more is the need to understand women’s motivations to support them make an informed decision.

      Keywords

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