RecruitingNCT06143072

CArE for OAsI Study: Care Pathways and Anorectal Evaluation for OASI Associated Incontinence

Referral Pathways and Care Provision for Patients Who Develop OASI Associated Incontinence in the First Five Years Following a Vaginal Delivery

Sponsor

London North West Healthcare NHS Trust

Enrollment

112 participants

Start Date

Jan 1, 2024

Study Type

OBSERVATIONAL

Conditions

Obstetric anal sphincter injury Anal incontinence Faecal Incontinence Follow-up Biofeedback Urgency Severe Perineal Trauma Grade 3 Perineal Tear Grade 4 Perineal Tear Deferral Time Pathways Review Endo-anal Ultrasound Urogynaecology

Summary

The aim of this study is to ascertain which pathways currently exist in relation to the follow up of patients with obstetric anal sphincter injury related incontinence. This is particularly important as afflicted individuals may not readily volunteer information about their symptoms and struggles and need to be safeguarded by the presence of robust care pathways that ensure adequate follow up and care provision. As obstetric anal sphincter injuries have been associated with increased litigation rates over the years, positive interventions towards patient care will help ameliorate the financial burden that litigation carries on the National Health Service. It is noteworthy of mention that perineal injury, in itself, may not be suggestive of negligent care and is a recognized complication of vaginal delivery. However, a failure to adequately manage the injury may carry medicolegal implications.

Eligibility

Sex: FEMALEMin Age: 18 YearsMax Age: 50 Years

Inclusion Criteria7

Part 1 of Study
Fertile women ≥ 18 years and ≤50 who have developed OASI related incontinence following a vaginal delivery in the preceding five years (N.B. the average age of menopause in the UK is 51)
Tertiary referrals to the specialist perineal clinic as well as patients who have 'slipped' through the existing pathway of referral
Capacity to consent (able to comprehend and retain information, weight out the risks and benefits and communicate a decision back to the researcher)
English-speaking and able to comprehend and read English
Primiparous/multi-parous
urogynaecologists/obstetricians who oversee the care of or look after patients with OASI and who are practising in UK NHS hospitals at the time of completion of the survey. They must be on the GMC specialist register to be eligible to participate

Exclusion Criteria7

Women who are unable to consent or who have severe mental illness, as decided by the screening clinician
Patients who do not speak, read or understand English
Patients with an alternative documented cause for their FI that is non obstetric trauma related.
Post-menopausal women who may develop late onset symptoms of incontinence relating to a previous OASI (clinically silent injuries that manifest in later life secondary to hormonal influences or advancing age for example).
Women with an OASI who have been referred directly from the maternity unit at the same trust as the specialist perineal clinic, where an existing trust policy exists for direct referral of these patients from the maternity unit to the perineal clinic.
Part 2 of study:
trainees, obstetricians/gynaecologists not routinely involved in the care of OASI patients.