Abstract
Commentary on Obstetric perineal injury … by TD Naidoo and J Moodley
Obstetric perineal injuries, often termed obstetric anal sphincter injuries (OASIS) may be a cause of short- and long-term maternal morbidity. Its varying reported incidence probably reflects the degree of awareness and recognition, although there is some suggestion that the incidence may have increased in recent years. Predisposing factors for OASIS are well known and widely reported; the paper published in the journal aims to ascertain these in the sub-Saharan population and to look at its long-term complications. The study was, however, not designed to answer the latter; although there may be problems with anal incontinence in the short term, in many especially those related to pelvic organ prolapse, it may become apparent much later. In addition although elective Caesarean sections have been excluded, it appears that emergency Caesarean sections were not and should have been.
I have several comments to make in terms of the analysis. Factors that have consistently been associated with OASIS are nulliparity, duration of second stage, instrumental births (particularly forceps), birth weight and malposition. I am surprised that the authors have focused on multiparity (why parity 2 and above?), maternal height and weight (why not BMI?), duration of labour (why 6.3 hours or more) and birth weight (why 3 kg or more?). If only mediolateral episiotomies are performed why separate the results of mediolateral episiotomy from episiotomy?
Most of the discussion is hypothetical and does not relate to the results from the study. It would be of interest to have discussion on any similarity or otherwise of risk factors between the sub-Saharan population and those reported from non-African populations elsewhere. The discussion could also have focused on what recommendations could be made within their units to reduce the occurrence of perineal injuries.
Prof. M Kassam, MB CHB MD FRANZCOG
Ipswich Hospital, University of Queensland, Brisbane, Queensland, Australia