OASIS RCOG Flashcards
Evidence for protective effect of episiotomy and OASI?
reduced risk with assisted delivery
no clear evidence spontaneous delivery
‘judicious’
Recommendation re figure of 8 sutures during OASIS repair?
Avoid due to risk of tissue ischaemia
Repair of anorectal mucosa?
3-0 vicryl
interrupted or continuous
Repair of 3B or 3C EAS?
end to end 3-0 PDS
How to avoid knot and suture migration to skin?
bury knots beneath superficial perineal muscles.
Postoperative care recommendations OASIS?
laxatives
antibiotics
examination and FU 6-12 weeks
Prognosis after 3rd or 4th degree tear at one year?
60-80% asymptomatic at 12 months.
Risk of recurrence of 3rd or 4th degree?
5-7%
Risk of worsening OASIS incontinence symptoms after subsequent vaginal delivery?
17%
or up to 1/5
Overall incidence of OASIS in a) all, b) nullips, c) Multips
a) 2.9%
b) nullip = 6.1%
c) multip= 1.7%
Define 3C tear
Perineal muscles + skin + EAS + IAS torn
Risk of not recognising rectal button hole tears
rectovaginal fistula
Risk factors for OASI?
Asian, nullip, >4kk birthweight, shoulder dystocia, OP position, prolonged second stage, instrumental delivery (forceps>vacuum), no episiotomy with instrumental
Risk of OASIS with/without episiotomy in
a) vacuum
b) forceps
a) vacuum
- with OR 0.57 (0.51-0.63)
- without OR 1.89, 95% CI 1.74-2.05)
b) forceps
- with OR 1.34 (1.21-1.49)
- without OR 6.53 (5.57-7.64)
Risk of OASI with a) perineal massage, b)warm compress?
a) RR 0.48 (0.28-0.84)
b) RR 0.84 (0.74-0.95) NNTB 21
