Obstetric Anal Sphincter Injuries at Vaginal Delivery: A Review of Recently Published National Guidelines

Obstet Gynecol Surv. 2018 Dec;73(12):695-702. doi: 10.1097/OGX.0000000000000622.


Importance: Obstetric anal sphincter injuries (OASISs) complicate approximately 1 in 10 deliveries.

Objective: The aims of this study were to review and compare recommendations from recently published national guidelines regarding OASISs at vaginal delivery.

Evidence acquisition: Three national guidelines on OASISs at vaginal delivery are presented through a descriptive review: Royal College of Obstetricians and Gynaecologists on "The Management of Third- and Fourth-Degree Perineal Tears," American College of Obstetricians and Gynecologists on "Prevention and Management of Obstetric Lacerations at Vaginal Delivery," and Society of Obstetricians and Gynaecologists of Canada on "Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair." These guidelines were summarized and compared in terms of prevention and management of OASISs. Quality of evidence was also reviewed based on method of reporting for each guideline.

Results: This published evidence reflects the differences between the national recommendations on the prevention and management of OASISs. Especially, as for the prevention of OASIS, routine use of episiotomy is not recommended, whereas warm perineal compresses and perineal massage during the second stage of labor seem to have a protective role. In the management of OASIS, special care is needed during the repair process of the torn anorectal mucosa and the internal and external anal sphincter. The postoperative use of broad-spectrum antibiotics, oral laxatives, and analgesia is also recommended.

Conclusions: Summarized guidelines can have an impact on special care in prevention and management of OASIS; this may support the reduction of morbidity associated with that entity.

Publication types

  • Review

MeSH terms

  • Anal Canal / injuries*
  • Analgesia
  • Anti-Bacterial Agents / therapeutic use
  • Constipation / prevention & control
  • Delivery, Obstetric / adverse effects*
  • Episiotomy
  • Female
  • Humans
  • Lacerations / prevention & control
  • Lacerations / therapy*
  • Laxatives / therapeutic use
  • Postpartum Period
  • Practice Guidelines as Topic*
  • Pregnancy


  • Anti-Bacterial Agents
  • Laxatives