PATTERN OF PRESENTATION AND OUTCOME OF OBSTETRIC ANAL SPHINCTER INJURY (OASIS) REPAIR IN A NATIONAL FISTULA CENTRE, KATSINA

*Nasir S. and Sani MS.

ABSTRACT

Background: Obstetric anal sphincter injury is a cause of apparent morbidity in obstetric practice in Nigeria. This poses physical, social, mental and psychological challenge to the patients thereby jeopardising their quality of life. Objectives: The objectives of this study were to determine the pattern of presentation, prevalence and outcome after repair of obstetric anal sphincter injury at the National Obstetric Fistula Centre, Babbar–Ruga, Katsina (NOFICK). Materials and methods: This was a two-year retrospective review of all cases that underwent repair for obstetric anal sphincter injury at the National Obstetric Fistula Centre, Babbar Ruga, Katsina, Katsina State, North Western Nigeria from 1 Jan 2015 to 31 December 2016. NOFIC is the second national fistula centre in Nigeria. The tertiary health centre provides services to the obstetric fistula population in North West Nigeria and neighbouring countries such as the Niger Republic. SPSS 22 was used for data entry and analysis. Results: During the study period a total of 728 procedures were performed in the centre, out of which 61 (8.3%) were surgical repair for obstetric anal sphincter injury. Only 54 patients’ case notes were available for analysis giving a retrieval rate of 88.5%, and further analysis was limited to these cases. The mean age of the women was 24.22±7.0 with minimum age of 16 years and maximum age of 48 years. The mean parity of the women was 2.28±1.5. Majority (57.4%) of the women had quranic education with only 11.1% having tertiary level of education. The prevalence of obstetric anal sphincter injury was found to be 8.3%. Thirteen percent of the women presented with history of flatus incontinence while the remaining presented with the history of both flatus and faecal incontinence. A diagnosis of 3rd and 4th degree perineal tear was made in 24.1% and 75.9% of the women respectively. Seventy point four percent (38) of the women were delivered at home. Ten (62.5%) of the 16 patients that delivered in the hospital had instrumental vaginal delivery while the remaining had spontaneous vaginal delivery. History of episiotomy was obtained in 13 (24.1%) of the women that were delivered in the hospital. 79.2% of the babies delivered were male while 20.8 were delivered as females. Majority (83%) of the babies were delivered alive. History of delivery of a macrosomic (fetal weight of ≥4kg) baby was obtained in only 8 of the patients, 5 claimed that the fetal weight was <4kg and 41 could not remember/do not know the fetal weight at delivery. Previous history of perineal laceration was obtained in 79.6% of them. At discharge 87% were found to have healed successfully. Conclusion: The prevalence of 8.3% was high. Majority of the patients were young and having their first delivery. The contributing factors identified were younger age, primiparity, home delivery, use of episiotomy and instrumental vaginal delivery.

Keywords: Obstetric anal sphincter, Perineal tear, Flatus incontinence, Stool incontinence.