Obstetric Anal Sphincter Injury: Counseling for Future Deliveries

Madeline Freeman; Natasha G Rich; Lisa C Hickman; Katie Propst

doi:10.1016/j.ajog.2025.06.037

Obstetric Anal Sphincter Injury: Counseling for Future Deliveries

Am J Obstet Gynecol. 2025 Jun 24:S0002-9378(25)00415-6. doi: 10.1016/j.ajog.2025.06.037. Online ahead of print.

Authors

Madeline Freeman¹, Natasha G Rich², Lisa C Hickman³, Katie Propst⁴

Affiliations

¹ Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: madeline.freeman@osumc.edu.
² Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida.
³ Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
⁴ Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida.

PMID: 40571071
DOI: 10.1016/j.ajog.2025.06.037

Abstract

This article provides a comprehensive review of counseling in subsequent deliveries for patients with a history of obstetric anal sphincter injury (OASI). Patients with prior OASI are at increased risk for recurrent OASI compared to other multiparous patients, however, the rates of primary and recurrent OASI are similar at 4.4-11% and 3.7-13.4%, respectively. Subsequent delivery care includes a review of the index delivery course, acute postpartum complications, OASI sequelae, and patient risk factors. Counseling should include understanding the patient's values and preferences, a risk-benefit discussion of delivery modalities, and an appropriate recommendation for the subsequent mode of delivery. There are no absolute contraindications to subsequent vaginal delivery, and newer data suggests appropriate mode of delivery selection results in stable pelvic floor functional status. This highlights the importance of counseling for shared decision-making for future delivery planning.

Keywords: anticipatory guidance; birth trauma; incontinence; obstetric laceration; patient education; pelvic floor; pelvic pain; perineal tear; vaginal delivery.

Publication types

Review