Approximately 3,000,000 women have vaginal deliveries each year in the United States.
Five percent, (i.e., 150,000) of these women will experience an obstetrical anal sphincter
injury (OASIS). OASIS is associated with chronic pain and sexual dysfunction. Moreover, 25%
of women with OASIS will suffer from chronic accidental bowel leakage. In other words, one
new woman every 14 minutes experiences an injury that leads to uncontrollable leakage of
stool and gas. This woman is not only a new mother, but she may also be a teacher, a
construction worker, a nurse, a doctor, or an executive who will have to deal with this
devastating and embarrassing condition for the rest of her life. At age 45, women suffer from
accidental bowel leakage at a rate that is eight times higher than that of men of the same
age (1).
It is likely that accidental bowel leakage is related not only to the structural disruptions
that occur with OASIS, but also from complications, such as infection and poor wound healing.
Women who suffer OASIS are at high risk for infection and poor healing; this is not
surprising given that these lacerations are repaired and then continue to heal in a
contaminated field (near stool). Poor healing and infection in the setting of OASIS make
accidental bowel leakage, chronic pain, and sexual dysfunction even more likely (2-6).
Unfortunately, even those infections that are recognized early and treated can still cause
accidental bowel leakage decades after childbirth (7-9).
Despite the many women affected by OASIS and its debilitating ramifications through the arc
of a woman's life, there is a lack of evidence-based best practice to guide treatment and
follow-up when it does occur. Even though infection and poor healing compromise outcomes,
there are limited data regarding best practice to prevent of these complications. The use of
antibiotics at the time of OASIS repair has become common based on our division's previous
studies (15-18). However, no studies have been done to determine whether oral antibiotics
immediately postpartum can further decrease the incidence of short and long-term
complications. The Royal College of Obstetricians and Gynecologists recommends the use of
antibiotics after OASIS repair (10), however, the basis of this recommendation is founded
only on expert opinion. On the other hand, the American College of Obstetricians and
Gynecologists provides no recommendation with regard to whether antibiotics should be used in
the postpartum time. At our institution, almost all women who sustain OASIS during vaginal
delivery receive a single dose of IV antibiotics based on our previously published work at
Prentice, however, that while many physicians chose to administer oral antibiotics based on
expert opinions, it is unknown whether these provide any specific benefit - again as many
physicians chose to administer antibiotics regardless of the evidence to date. Standard care
postpartum both nationally and internationally is highly varied and likely based on physician
training and preference (11).
Therefore, there is a great need for a trial to determine whether the use of supplemental
antibiotics for 5 days postpartum will decrease rates of perineal wound infection and
breakdown and improve maternal health outcomes. Such a trial will guide best practice,
enhance the care of women, and potentially reduce the debilitating consequences of OASIS.