This RCOG Consent Advice (No. 9) provides guidance for clinicians on obtaining informed consent from women undergoing repair of third- or fourth-degree perineal tears (obstetric anal sphincter injuries, OASI) following childbirth, covering intended benefits, serious risks, frequent risks, and alternative treatments.
Key risk frequencies cited: faecal urgency 26/100 (very common), perineal pain and dyspareunia 9/100 (common), wound infection 8/100 (common); serious risks include anal/flatus incontinence (common), haematoma (rare), and rectovaginal fistula (very rare).
This is a consent guidance document, not a primary research study — risk estimates are drawn from referenced guidelines and one RCT rather than original data. Risk figures may not reflect contemporary practice or diverse populations.
When consenting women for OASI repair, clearly communicate that quoted complication risks are tied to the sphincter injury itself, not just the repair, and that leaving tears unrepaired increases risk further. Ensure future delivery mode (possible caesarean) is discussed if incontinence symptoms persist.
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