(Poster 158) Counseling After Obstetric Anal Sphincter Injury: How Do Providers Perform?

Objectives: This study aimed to evaluate the incidence and quality of counseling received by patients with a history of obstetric anal sphincter injury (OASI) in subsequent pregnancies. Secondary objectives included assessing the impact of counseling on delivery decisions, evaluating the influence of patient risk factors on counseling rates, and understanding the rationale behind delivery recommendations.

Methods: This descriptive cohort study was conducted through a retrospective chart review at two academic institutions. Patients who sustained an OASI in a prior delivery and received subsequent prenatal care and delivered at our institutions were included. Data were gathered on OASI risk factors, sequelae, and the presence and quality of counseling provided during the subsequent pregnancy. Counseling quality was quantified using a three-point scale based on the discussion of OASI sequelae, risk factors, and mode of delivery, including the appropriate recommendation for cesarean delivery per American College of Obstetrics and Gynecology practice guidelines.

Results: 218 patients met eligibility criteria, and of these, 39% (n=85) received counseling on OASI history in their subsequent pregnancy. The counseling quality was evenly distributed across poor (27%), weak (23.5%), moderate (23.5%), and strong (26%) scores. Patients who experienced fourth-degree lacerations (p < 0.01 ) or at least one OASI sequela (p < 0.01) were more likely to receive counseling. Other demographic and medical characteristics were similar between groups (Table 1). Mode of delivery recommendations were provided to 67% (n=54) of counseled patients and 31% (n=41) of those not counseled, with adherence rates of 83% and 93%, respectively. Adherence did not significantly differ based on the presence (p=0.17) or quality (p=0.14) of counseling. Among those counseled, 20% (n=17) were recommended to undergo cesarean delivery due to OASI history; of these, 88% (n=15) received moderate to strong counseling, and 58.5% (n=10) followed the recommendation. The cesarean delivery rate was significantly higher in counseled patients compared to non-counseled patients (p < 0.01) (Table 2). Notably, 61.9% (n=13) of cesarean deliveries in the counseled group were performed specifically for OASI history, compared to none in the non-counseled group.

Conclusions: Less than half of patients with an OASI history received counseling in subsequent pregnancies, and of those who did, only half received high-quality guidance. Overall, counseled patients had an increased cesarean delivery rate. Higher quality counseling (moderate to strong) was associated with a higher recommendation rate for cesarean delivery for OASI history. Adherence to mode of delivery recommendations was generally high, regardless of whether counseling was received. While not statistically significant, adherence to mode of delivery recommendation tended to decrease with increased counseling quality, despite the appropriateness of the recommendation. Further research is needed to understand patient motivations for delivery planning and the role counseling plays in shaping these decisions.