Methods of repair for obstetric anal sphincter injury
RHL practical aspects by Quijano C
FIRST CONTACT (PRIMARY CARE) LEVEL
Following vaginal delivery if damage to perineal muscles is observed, the woman must be referred immediately to a hospital.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
The following are needed to repair obstetric anal sphincter injuries in women:
- Human resources. An experienced surgeon should be able to recognize the damaged structures. The anatomy should be reconstituted layer by layer (rectal mucosa, internal and external sphincter, vaginal mucosa, superficial transverse muscle, and perineal skin). The sphincter may be sutured using either the end-to-end technique or the overlapping technique.
- Material resources. The following should be available for the operation: an operation theatre with good lighting, aseptic conditions (gloves, sterile gauzes and compresses, disinfectant solutions), local/regional or general anaesthesia, set of instruments (forceps/dissecting and ligatures, Adson baby haemostatic forceps, scissors, needle, vaginal retractors, anoscope), and absorbable suture (braided multifilament polyglicolic and polydioxanone).
- Follow-up. For immediate follow-up prescribe antibiotic cover and a laxative. Long-term follow-up requires assessment by anal endosonography and constipation control. If the woman plans to have another baby, the mode of delivery in next pregnancy should be discussed with the woman.
AT HOME OR IN THE COMMUNITY
This document should be cited as: Quijano C. Methods of repair for obstetric anal sphincter injury : RHL practical aspects (last revised: 27 August 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.