Association between severities of striae gravidarum and Obstetric Anal Sphincter Injuries (OASIS).

ABSTRACT

OBJECTIVES: to examine the association between the severities of Striae Gravidarum (SG) and Obstetric Anal Sphincter Injuries (OASIS) and to measure the symptoms regarding urinary incontinence, fecal/flatus incontinence, and dyspareunia, at 6 and 12 months postpartum. DESIGN: this is a cohort study. SETTING: four university teaching medical centers in Israel, two in the north and two in the center of the country. PARTICIPANTS: women with OASIS were interviewed and assessed for SG. OASIS was divided into 4 groups 3A, 3B, 3C and 4. Inclusion criteria wereOASIS diagnosis, non-instrumental vaginal childbirth, birth between 37 and 42 gestational weeks, singleton newborn, neonatal birth weight of Severity scoring of SG severity scoring, using Atwal's Numerical Scoring System,observed 4 body sites; Abdomen, Breasts, Hips, and Buttocks., Total severity score (TSS) for all sites range between 0 and 24 and categorized 0-3 no SG (NSG) and 4 and over SG. The Pelvic Floor Symptom Bother Questionnaire (PFBQ),a validated, structured questionnaire, was used for the 6 and 12 month follow-up assessments, with nine items regarding pelvic floor dysfunction (urinary and bowel impairment uterine prolapse and sexual function). MEASUREMENTS AND FINDINGS: eighty women who had OASIS were enlisted, interviewed and assessed for SG. The average score for women with some SG was 6.10 (SD = 4.12). There were 58 (72.5%) women with OASIS level 3A; 12 (15%) had 3B; 4 (5.0%) had 3C and 6 (7.5%) had 4th degree anal injuries, respectively. Forty two (52.5%) of the women had SG and 38 (47.5%) had no SG. There was no association between SG severity and OASIS (3A, 3B, 3C+4th) χ2 (6) = 8.4014; p = 0.2. As there were only 10 women with OASIS of 3C and 4, we re-analyzed the association between SG severity and OASIS severity of 3A and 3B. There was a significant association between SG severity and OASIS severity (3A, 3B) χ2 (3) = 9.306; p = 0.025. ADDITIONAL FINDINGS: women with SG were younger (mean = 26.74, SD = 3.57) than women without SG (mean = 29.29, SD = 4.40) (t(78) = 2.86, p = .005). Three symptoms had a significant reduction in the bother degree between 6 and 12 months urinary incontinence (p = 0.017), flatus incontinence (p = 0.031) and sexuality (p = 0.016). KEY CONCLUSIONS: the innovation of this research is the association between SG severity and OASIS severity (3A, 3B), added information regarding OASIS risk factors.