Video of Obstetric Anal Sphincter Injuries (OASIs) Identification and Repair - Tips and Tricks!
IUGA Academy. Taithongchai A. Jun 30, 2018; 213276
Annika Taithongchai
Annika Taithongchai

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Video of Obstetric Anal Sphincter Injuries (OASIs) identification and repair – Tips and Tricks!

Taithongchai, A1; Sultan, A1; Thakar, R1

1: Croydon University Hospital

Introduction: Diagnosis and repair of obstetric anal sphincter injuries (OASIs) are a poorly covered topic during training. There is evidence that the best outcomes are achieved from correct diagnosis of OASIs and primary surgical repair by appropriately trained doctors1. An evaluation of the effectiveness of a structured course has shown that this is a necessary adjunct to clinical surgical training for obstetrics and gynaecology trainees, as otherwise the understanding and repair technique is suboptimal2. However, despite widespread recognition and improved teaching on OASIs, there is still an on-going concern regarding the accuracy of clinical diagnosis of OASIs3.

Objective: To provide tips and tricks to help improve the clinical diagnosis of OASIs by providing a visual demonstration of the appropriate examination technique following vaginal delivery to correctly identify the extent of perineal injury as well as the subsequent surgical repair. Although it is documented that a rectal examination is performed following vaginal delivery, the examination is not comprehensive or systematic. The nature of the injury, active bleeding, and the limited visual field for repair makes the anatomy difficult to distinguish. Our objective is to provide tips and tricks to help correctly identify the external and internal anal sphincters and surrounding anatomy in these conditions to enable accurate diagnosis and appropriate apposition of the sphincter muscles.

Methods: This video will contain clips demonstrating a systematic rectal and vaginal examination post vaginal delivery to correctly identify the different grades of OASIs as well as tips on how to differentiate between internal and external anal sphincter muscles. This video will also include tips and tricks on how not to over-diagnose OASIs, demonstrate anatomical landmarks and ensure optimum preparation before repair. Finally the video will demonstrate the technique of repair of the external and internal anal sphincter.

References: 1. Ultrasound Obstet Gynecol. 2010;36(3):368-74 2. Int Urogynecol J Pelvic Floor Dysfunct, 2009;20(11):1397 3. Ultrasound Obstet Gynecol. 2017;50(5):642-647


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