Follow up for Specialty Postpartum Care After Obstetric Anal Sphincter Injury

Objectives: The American College of Obstetrics and Gynecology recommends that birthing people follow up with their provider within 3 weeks of delivery; however, traditionally follow-up rates are low. Short interval follow-up is particularly important in people who experience obstetric anal sphincter injury (OASI) to improve outcomes and prevent long-term sequelae. A urogynecologist-led postpartum recovery clinic (PPRC) was created at our institution to address this need. The objective of this study was to describe follow-up rates in PPRC for patients who had OASI at delivery, and identify factors associated with failure to follow-up.

Methods: This was an IRB-approved retrospective cohort study of patients who sustained third- and fourth-degree perineal lacerations at a single institution from January 2021- December 2023. Patients who sustain OASI receive an automatic referral to PPRC within 3 weeks postpartum. Demographic and obstetric data were abstracted from patient charts, including the Edinburgh Postpartum Depression Scale (EPDS) score at time of discharge. We compared those who did and did not follow up in PPRC using univariable analysis (Chi-squared for categorical variables, t-test for continuous variables) and multivariable logistic regression.

Results: Three hundred and five patients sustained OASI during the study period. Of these, 273 (89.5%) followed up in PPRC and 32 (10.5%) did not. The median time to follow-up was 13 days (range 2-124 days). Of those who followed up, 218 (79.9%) followed up within 3 weeks and 55 (20.2%) after. Patients who attended PPRC were significantly older than those that did not (mean 32.4 ± 3.8 years vs 29.4 ± 5.2, p= < 0.001). Failure to follow up was associated with Black race, not speaking English as a primary language, having Medicaid or state insurance, and higher EPDS score on univariable analysis (Table 1). Those who scored ≥10 on EPDS (indicating increased risk for depression) had lower follow-up rates than those with lower scores (74.1% for patients who scored ≥10 vs 91.2% for those with lower scores, p=0.01). On multivariable analysis, EPDS score ≥10 (aOR 0.29, 95% CI 0.10-0.81) and having Medicaid or state medical assistance (aOR 0.31, 95% CI 0.10-0.90) remained associated with failure to follow up in PPRC (Table 2).

Conclusions: There was a high overall attendance rate (89.5%) to a urogynecologist-led postpartum recovery clinic in birthing people who sustained OASI, with 79.9% following up within 3 weeks. Factors associated with failure to follow up include an elevated EPDS score and having Medicaid/state medical assistance. Future work should focus on ways to improve attendance by addressing insurance and mental health barriers to receiving specialized postpartum care.