OASIS (Obstetric Anal Sphincter Injuries)

Oleh
Hendra Santoso
Pembimbing
Dr. dr. Imam Ahmadi Farid Sp.OG(K)
 OASIS (Obstetric Anal Sphincter Injuries)
• Third or fourth degree perineal tears
Incidence of OASIS
• The reported rate of OASIS (in singleton, term, cephalic, vaginal first
births) in England has tripled from 1.8% to 5.9% from 2000 to 2012
Risk Factors
• Asian ethnicity
• Nulliparity
• birthweight greater than 4 kg
• shoulder dystocia
• Occipito posterior position
• Prolonged second stage of labour
• Instrumental delivery
Identification of OASIS
• All women having a vaginal delivery are at risk of sustaining OASIS or
isolated rectal buttonhole tears.
• They should therefore be examined systematically, including a digital
rectal examination, to assess the severity of damage, particularly prior
to suturing
Repair of OASIS
• Repair of third- and fourth-degree tears should be conducted by an
appropriately trained clinician or by a trainee under supervision

• Repair should take place in an operating theatre, under regional or

general anaesthesia, with good lighting and with appropriate
instruments

• If there is excessive bleeding, a vaginal pack should be inserted and

the woman should be taken to the theatre as soon as possible
Repair of OASIS
• Repair of OASIS in the delivery room may be performed in certain
circumstances after discussion with a senior obstetrician

• Figure of eight sutures should be avoided during the repair of OASIS

because they are haemostatic in nature and may cause tissue ischaemia

• A rectal examination should be performed after the repair to ensure

that sutures have not been inadvertently inserted through the
anorectal mucosa
Technique of Repair
• Anorectal mucosa: continuous or interrupted technique

• IAS: repair this separately with interrupted or mattress sutures (NO

OVERLAP)

• Full thickness EAS tear: overlapping or an end-to-end method

• Partial thickness EAS ( all 3a and some 3b) tears: end-to-end

technique (NO OVERLAP)
Suture Material
• Anorectal mucosa:
 3-0 polyglactin (preffered) causes less irritation and discomfort

• EAS and/or IAS muscle:

 either monofilament sutures such as 3-0 PDS or modern braided
sutures such as polyglactin can be used with equivalent outcomes
Post-Op Management
• Broad-spectrum antibiotics: recommended –reduce the risk of post
operative infections and wound dehiscence

• Post operative laxatives: recommended to reduce the risk of wound

dehiscence

• Physioterapy following repair of OASIS could be beneficial

Prognosis
• 60-80% of women are asymptomatic 12 months following delivery
and EAS repair
Future Pregnancy
• All women who sustained OASIS in a previous pregnancy should be
counselled about the mode of delivery and this should be clearly
documented in the notes
• The role of prophylactic episiotomy in subsequent pregnancies is not
known and therefore an episiotomy should only be performed if
clinically indicated
• All women who have sustained OASIS in a previous pregnancy and
who are symptomatic or have abnormal endoanal ultrasonography
and/or manometry should be counselled regarding the option of
elective caesarean birth
•THANK YOU