Care of women and prevention of obstetric anal sphincter Injury (OASI) during childbirth has been highlighted in recent years following NICE Guidelines and focus from the Royal College of Obstetricians and Gynaecologists of England which aim to try and reduce OASI injury risk via intra partum manoeuvres and highlighting patients at particular risk in the perinatal period. The diagnostic rate of confirmed grade 3 and above sphincter injury at time of delivery has increased in accordance with this greater awareness and better diagnosis. We recognised the need for improved and collaborative care for these women post-partum between Colorectal Surgeons and Obstetricians and so created the first ‘One Stop’ OASI Clinic specifically designed for women identified at delivery to have grade 3a injury and above.The aim of this study was therefore to describe the set up of a One Stop OASI Clinic in a hospital outpatient setting and describe the initial results.

The One Stop OASI Clinic was created in October 2020 in accordance with the model proposed by NICE for endoanal US (EUS) at 12 weeks, in combination with patient history, clinical examination and anorectal physiology (ARP) and scheduled every 2 weeks. Patients diagnosed with grade 3a or above OASI at delivery are booked into clinic for their first appointment at around 12 weeks post -delivery. Midwives and medical team from Obstetrics can refer to the One Stop OASI Clinic directly. A single pro forma was completed for each patient in clinic including demographic details, mode of delivery and relevant intra partum details, a modified symptom ‘Stark Score’ and qualitative assessment with ARP and EUS and any other relevant information.  Patients were all examined jointly by colorectal and obstetric clinician.

15 new clinic patients were seen in the first 6 months of the clinic with an average Stark score of 3. 13/15 women presented with grade 3b sphincter injury between 10- and 14-weeks post-partum, of whom 8 were asymptomatic at presentation despite significant sphincter damage (>30degrees on EUS in 6/8 (range 30-120 degrees), no damage on 2/8). All women were offered advice on conservative management of symptoms, including stool consistency, toileting, and pelvic floor exercises as standard. 5/15 women were referred for pelvic floor physiotherapy, one for formal ARP and biofeedback and all for open follow up appointment.

The most significant finding of our results thus far was the high percentage of women who were asymptomatic at presentation three-months post-delivery on assessment in clinic. Despite often having significant sphincter injury demonstrable on EUS, the clinical correlation was not compatible which was reflected in the low overall average clinical symptom Stark score recorded.

These results demonstrate that an OASI One Stop Clinic can be successfully implemented in an outpatient hospital setting. Patient engagement has been strong with no non-attendances at clinic and referrals appropriate. We demonstrate that patients are often asymptomatic at 12 weeks post OASI and have a low Stark score despite often significant defects demonstrated on EUS. This reinforces that conservative approach to management of OASI is appropriate the first instance, with reassurance and careful support in follow up. Patients can be counselled early that treatment would likely be limited to physiotherapy and biofeedback as necessary. We intend to collect long term follow up patient satisfaction which will help to shape the future of services for women in our care.