Impact of COVID-19 on Obstetric Anal Sphincter Injury (OASI) Management at a District General Hospital 

AIMS To review the management and follow up of patients who had an OASI over the last 2 years at our unit. This was during the COVID-19 pandemic. To analyse any common themes and propose a “one-stop” multidisciplinary perineal trauma clinic to improve patient care and standardise follow up. METHODS A retrospective case note review was carried out of 113 patients who sustained obstetric anal sphincter injury between November 2020 to November 2022 at Calderdale Royal Hospital. RESULTS • The incidence was 1.13% (113/10,000) • 11.5% (13/113) had a previous OASI • The mode of delivery included 65% (73/113) unassisted vaginal birth, 30% (34/113) forceps, 4.4% (5/113) ventouse delivery and 0.9% (1/113) a vaginal breech delivery

RESULTS 

• he category of obstetric anal sphincter injury were as follows: 50% (56/113) had a 3A tear, 35% (40/113) 3B, 8% (9/113) 3C and 7% (8/113) sustained a 4th degree tear. 

• 91% (103/113) were discharged with antibiotics and laxatives. 

• No patients were documented to have received written information regarding OASI.

• 63% (71/113) women were reviewed by a colorectal nurse specialist in a perineal trauma clinic, a further 17% (19/113) did not attend (DNA).

• 56% (63/113) women received a women's health physiotherapy appointment however 19% (12/63) DNA. 

• Due to COVID-19 pandemic the consultation was conducted via telephone. 

• Of those who attended, 48% (34/71) were symptomatic at 3 months. 

• 2.8% women (2/71) were recorded as symptomatic at 6 months due a lack of data as the majority of women were discharged at 3 months. 

• 9.9% (7/71) had an endoanal ultrasound, there was no standardised operating procedure for interpretation or management.