Publication:

Stepwise surgical repair of complete perineal tear (OASIS): a 20-year retrospective study of 200 referred cases at a tertiary care centre in Bundelkhand region

Background Obstetric anal sphincter injuries (OASIS), comprising third- and fourth-degree perineal tears, are severe obstetric complications leading to significant maternal morbidity including fecal incontinence, perineal pain, wound dehiscence, dyspareunia, rectovaginal fistula formation, and psychological distress. This study aimed to evaluate demographic and obstetric characteristics of referred complete perineal tear cases managed at a tertiary care centre and to describe a standardized stepwise surgical repair protocol with functional and cosmetic outcomes.

Methods A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India, from January 2005 to December 2025. A total of 200 referred cases of complete perineal tear were included. Surgical repair was performed after 24 hours of delivery.

Results Among 200 patients, 50% were aged >25 years and 70% were primigravida. Post-term deliveries accounted for 55% of cases. Birth weight was >3 kg in 50% of cases. Episiotomy was not given in 85% of cases. Saddle anaesthesia was used in 75% patients. Hospital stay was 14 days in 55% of patients.

Conclusions Complete perineal tears were more frequent among primigravida and post-term deliveries, especially with neonatal birth weight >3 kg. Delayed repair following a standardized stepwise anatomical reconstruction protocol resulted in satisfactory functional and cosmetic outcomes.