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 with 18.18% indicating bothersome symptoms. These figures align with Evans et al. (14) , but are lower than observed by Visscher (16) . Vaginal symptoms were noted in 50% of patients, with dyspareunia (31.82%) and perineal pain (36.36%) being the most common complaint - rates consistent with those reported by O’Shea (47%) and Visscher (59%) (15,16) . Up to 45.45% of patients were sexually active and 31.82% reported experiencing sexual dysfunction, correlating closely with the 31.2% and 34% respectively reported by Lewicky (17) and by O’Shea (15) underscoring the sexual health burden post-OASI. Two patients reported wound dehiscence, a rate lower than the incidence of 4/100 women reported by Okeahialam and Wong et al (38) . Additionally, one patient reported psychological symptoms manifesting as depressive thoughts related to her delivery and hospitalisation. Evans and Ramage describe that between 26% and 70% of women reported mental health symptoms (13,14) . This highlights a critical and under-recognised dimension of postpartum recovery as it may adversely affect maternal-infant bonding and overall quality of life. Imaging Insights Consistent with Dietz the strongest predictors for residual TPUS defects were primiparity and assisted delivery (35) . However, no forceps deliveries were observed in our cohort, and ventouse-assisted delivery was linked to defects in only two patients. Additionally, elevated BMI emerged as an additional risk factor (50%, n = 8/14), a factor not previously reported by Dietz. Fourth-degree perineal tears exhibited the strongest association with residual TPUS defects (64%, n = 9/14) compared to grade 3b (14%), 3a (7%), and 3c (7%) tears. Residual EAS and IAS defects were each observed in 55% of cases, mirroring rates reported by Guzman-Rojas (54% and 55%, respectively). Study strengths and limitations The study faced limitations due to a small sample size and low follow-up rates, restricting definitive associations between TPUS findings and symptoms. Participation bias may have influenced results, as symptomatic patients were more likely to attend follow-ups. Incomplete surgical records hindered repair technique analysis, and no validated postpartum-specific questionnaires for pelvic floor dysfunction or sexual dysfunction were used. Anal manometry was omitted due to equipment limitations and its absence in standard practice. Despite these challenges, recall bias was minimized by obtaining obstetric history directly from patients and cross-referencing electronic records. The physician-administered SMIS reliably assessed AI severity. Prospective data collection ensured real-time documentation, allowing immediate clarification of clinical and ultrasound uncertainties for improved accuracy in findings. Management Outcomes and Clinical Relevance While follow-up rates limited longitudinal assessment, those reviewed demonstrated improvement in UI and sexual symptoms, suggesting the benefit of early physiotherapy and targeted interventions. Importantly, one patient opted for sphincteroplasty after failed conservative management, underlying the need for tiered pathways. CONCLUSION We present a LMIC perspective of the outcomes and management of OASI in comparison to existing global literature as well as studies from other LMICs. It is evident that the burden of OASI on women is substantial, as many women continue to endure persistent symptoms even after surgical intervention with significant repercussions on their daily lives and alongside the broader implications for the healthcare system. Despite the inherent challenges faced in LMIC settings, our outcomes and management approach are comparable to those reported internationally. Future research should focus on validating symptom- specific tools, assessing long-term outcomes beyond the early post-partum period, and evaluating scalable, cost- effective interventions. These findings support the broader application of structured perineal care models in LMICs to reduce morbidity, improve quality of life and optimise health system efficiency. Declaration: The research for this study was done in partial fulfilment of the requirements for postgraduate MMed in Obstetrics and Gynaecology at Stellenbosch University. Acknowledgements: The authors would like to thank the women who participated in the study. Author contributions: All authors contributed to this article. Funding: There were no financial or non-financial interests which could inappropriately influence this research, and no remuneration was received by any parties. Conflicts of interest: None REFERENCES ¦ © ª ¤ ¦ ¬ ¡ ¦ ¬ £ ¦ ® ¦ ¦ ¬ ¯ ‐ ‐ African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 15