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Anal Sphincter injury (Third and forth degree tears) at vaginal delivery is the most common cause of feacal incontinence in otherwise healthy women. Obstetric injures complicate 0.5 -15% of vaginal deliveries. However, prevention of injury would obviate the need for surgical repair and associated short term morbidty. Patients and obstetrician have the universal desire to limit the incidence of injuries. It is however an unfortunate paradox that most of the risk factors for anal sphincter injures (primiparity, instrumental deliveries birth weight 7.4 kg) are components of normal labour and delivery process. The Majority of the women with these risk factors deliver vagnially, and sustain injuries. Several studies have identified a number of obstetric risk factors associate with sphincter injury. These include, nulliparty, large birth weight more than 4000 gms, forceps delivery, ventous delivery, epidural, induction of labour, delay in second stage of labour and persistent occipito posterior position of the fetus. Episiotomy appeared to be protective against sphincter injury, but evidences indicates that this may not be so. Recognized obstetric anal sphincter injuries (OASIS) occur in 0.4 – 19% of vaginal delivery in centers practicing mediolateral and midline episiotomies respectively. Previously there was confusion in classification of anal sphincter injuries. After having an audit on concept of classification, now a new classification was suggested, and this has now been accepted by the RCOG and the international consultation on incontinences (Table 1) OASIS therefore represent third and fourth degree tear.

Association and Outcome of the Primary Repair of Obstetric Perineal Injuries