AFJOG

ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | Outcomes of Primary Sphincteroplasty for Obstetric Anal Sphincter Injuries in a Resource-limited Setting : A Prospective Case Series postpartum haemorrhage (PPH) being the most common complication (18.18%). Fourth-degree tears comprised the largest proportion of OASI cases (45.45%), followed by grade 3b (27.27%), and unspecified third-degree tears (18.18%). Labour and Delivery Details The majority of deliveries (77.27%) were midwife-attended, followed by medical officers (13.64%) and registrars (4.55%). No deliveries were conducted by consultant obstetrician-gynaecologists, and 1 patient was unattended during delivery. Among the four patients with AI symptoms, two had fourth-degree perineal tears, while the others had grade 3b and unspecified third-degree tears, respectively. Of these four patients, two were VBAC deliveries. Delivery was conducted by a registrar in one case and the remaining three were delivered by midwives. Neonatal birthweight for this subgroup of patients ranged between 3200 – 3400g, with an average gestational age of 38 weeks. One patient experienced a complication of PPH. All four received OASI repair within 24 hours of delivery – three by medical officers and one by a provider with unspecified surgical expertise. Repair Data Most OASI repairs (45.45%) were performed within 24 hours of injury, with the largest proportion being repaired at Level 2 Hospital (41%). Medical officers performed the majority of repairs (77.27%), followed by registrars (13.64%) and consultants (4.55%), while one case lacked documentation of the surgeon’s rank. The overlap technique was favoured (31.82%) over the end-to-end technique (13.64%). However, surgical technique was undocumented in 54.55% of cases. Antibiotic prophylaxis was administered in 91% of cases, with cefazolin used in 71%, and co-amoxiclavulanic acid prescribed post-operatively in 59.09% of patients. Table 1: Characteristic Number (n = 22) Baseline demographic characteristics and major risk factors Patient age in years, mean (range) 25.05 (16-37) SD = 5.696 Gravidity, mean (range) 1.4 (1-4) SD = 0.778 Parity, mean (range) 1.3 (1-3) BMI kg/m2, mean (range) 25.66 (17.5 – 37.2) SD = 5.83 smoker 9% (n = 2) Risk Factor No risk factors 9 (41%) Raised BMI 9 (41%) Birth weight > 4kg 1 (5%) Shoulder dystocia 1 (5%) Prolonged second stage 1 (5%) Ventouse delivery 3 (14%) Degree of tear 3a 1 (4.55%) 3b 6 (27.27%) 3c 1 (4.55%) 4 10 (45.45%) 3 - not specified 4 (18.18%) Birth weight 3345g (2380 – 4600g) SD +/- 430.53 Gestation 39.4 weeks (SD 0.908, range 37 – 41 weeks) Labour and Delivery Data Delivery Facility MOU 4 (18.18%) District Hospital 6 (27.27%) Level 1 Hospital 6 (27.27%) Level 2 Hospital 2 (9.09%) Tygerberg (tertiary) Hospital 3 (13.64%) Other 1 (4.55%) Delivery Type Induction 6 (27.27%) Spontaneous 16 (72.73%) Normal vaginal delivery 17 (77.27%) Ventouse 3 (13.64%) Vaginal birth after caesarean section 2 (9.09%) Episiotomy use Yes 7 (31.82%) No 12 (54.55%) Not specified 3 (13.64%) Attendant at birth Midwife 17 (77.27%) Medical officer 3 (13.64%) Registrar 1 (4.55%) Consultant 0 Unattended 1 (4.55%) Repair Data Facility Tertiary : Tygerberg Hospital 7 (32%) Level 2 Hospital 9 (41%) Level 1 Hospital 4 (18%) Local Hospital 1 (5%) Other 1 (5%) Antibiotic use Yes 90.91% No 9.09% Level of expertise of surgeon Medical officer 17 (77.27%) Registrar 3 (13.64%) Consultant 1 (4.55%) Not specified 1 (4.55%) Technique of Repair Overlap 7 (31.82%) End-to-end 3 (13.64%) Not specified 12 (54.55%) Time from delivery to repair Within 24 hours 10 (45%) – 3 Tertiary, 2 Level 2, 3 Level 1, 1 District, 1 other 24 – 48 hours 9 (41%) – 2 Tertiary, 6 Level 2, 1 Level 1 More than 48 hours 3 (14%) – 2 Tertiary, 1 Level 2 Table 2: Of total (n = 22) Of symptomatic (n = 16) Bowel symptoms 18.18% (n = 4) 25% Bladder symptoms 22.73% (n = 5) 31% Vaginal 50% (n = 11) 69% Sexual dysfunction 31.82% (n = 7) 44% Psychological 4.55% (n = 1) 6% Symptom Distribution and Burden 72.73% of patients reported symptoms at their visit to the Perineal Clinic, ranging from bowel symptoms (18.18%), bladder symptoms (22.73%), vaginal symptoms (50%), African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 12