What are the names of the two brothers who fronted the hit 90’s band Oasis?
Noel and Liam Gallagher
What is the recurrence risk of an obstetrical anal sphincter injury?
4-8%
Describe the extent of injury in each of:
3a tear
3b tear
3c tear
3a: <50% of external anal sphincter involved
3b: >50% of external anal sphincter involved
3c: internal anal sphincter involved
What can be given to reduce the risk of complications if 3rd degree tear diagnosed?
1) IV antibiotics -single dose of 2nd generation cephalosporin, cefoteten, or cefoxitim
2) laxatives
3) analgesia -tylenol/NSAID recommended, caution with opiates due to constipation
4) pelvic floor physiotherapy if anal incontinence
Name potential long-term complications of an OASIS?
- anal incontinence
- pain/dyspareunia
- abscess
- altered sexual function
- wound breakdown
- recto-vaginal fistulae
Which patients should get a DRE prior to repair according to the SOGC guideline?
Any patient with a tear > 1st degree prior to suturing
What is the rate of OASIS (3rd or 4th degree tear)?
4-6% of SVDs
What are the risk factors for OASIS? (There are many)
Maternal: primiparity, age > 35, race, DM, infibulation, obesity (protective)
Delivery: AVD (forceps > vacuum, but vacuum + forceps OR 8), episiotomy, epidural, 2nd stage > 1h, shoulder dystocia, VBAC, water birth, oxytocin augmentation
Infant: BW>4kg, malpresentation, post maturity, fetal distress, OP
What interventions protect against OASIS?
head control
perineal support (evidence mixed)
warm compresses to perineum
intrapartum perineal massage
