FACTORS INFLUENCING PATIENTPREFERENCE OF MODE OF DELIVERY FOLLOWING AN OASI
S. JHA, E. LONG;
Urogynaecology, Sheffield Teaching Hosp., Sheffield, UnitedKingdom.
Introduction: For the past 30years, the World Health Organisation has stipulated that the optimalcaesarean section rate was between 10 and 15%, with rates that werehigher failing to have an impact on maternal and infant mortality.There is a growing concern worldwide regarding the current trend ofincreasing caesarean section rates, and its impact on both mothersand babies1 . The national caesarean section rate in theUnited Kingdom is following this rising trend, comprising 26.2% ofdeliveries in 2013-14. Just under half of these were electivecaesarean sections (44%)2. A caesarean section carrieswith it both long term and short term morbidities, and as such shouldnot be a procedure carried out without due thought and consideration.There are many indications for an elective caesarean section, one ofwhich is a previous obstetric anal sphincter injury (OASI). It doesnot follow that every patient who has sustained a previous OASIrequires a caesarean section. The Royal College of Obstetricians andGynaecologists recommend that women who have sustained OASIS in aprevious pregnancy and who are symptomatic or have abnormal endoanalultrasonography and/or manometry should be counselled regarding theoption of elective caesarean birth3.
Objective:The aim of this study was to identify reasons why women with OASIchoose to have elective caesarean in a subsequent pregnancy when theyare deemed suitable for a vaginal delivery.
Methods: 100consecutive women attending a Perineal trauma clinic having sustainedan OASI in a Tertiary teaching hospital were asked to complete aquestionnaire. This analysed the factors that influence patientpreferences regarding subsequent deliveries. In addition theycompleted ePAQ-PF to assess pelvic floor symptoms. Statisticalanalysis was done using SPSS.
Results: In total, 75 womenwere Primips and 25 Multips. 20% of patients were advised to have acaesarean, with the remainder advised either a vaginal delivery orfurther investigations. 21% of women had a 3c/4th degreeOASI. Based on women’s preferences, those who sustained a 3c/4thdegree tear were more likely to opt for a CS than a 3a/b degree tear(p<0.001). Bowel symptoms per se did not correlate with choice ofMoD in either group. In women with 3c/4th OASI vaginal orsexual symptoms did not impact on the decision making regardingchoice of delivery but in women who sustained a 3a/b tear the impacton sexual function appears to be the commonest symptom in those whowished a caesarean section.
Conclusions: Women with 3c/4thOASI are more likely to opt for a CS. Bowel symptoms appear to havelittle impact on this decision but in women with lower grades tearssexual symptoms have the greatest impact on decision regardingMoD.
References: 1. World Health Organisation statement onCaesarean Section rates. 1-4-2015.2. HES data 2013/14. 2016.http://digital.nhs.uk/catalogue/PUB16725/nhs-mate-eng-2013-14-summ-repo-rep.pdf.3.RCOG. Third- and Fourth-degree Perineal Tears, Management No 29.Green Top Guideline No 29 . 12-6-2015.