Preoperative risk factors for conversion from laparoscopic to opencholecystectomy: a validated risk score derived from a prospective U.K.database of 8820 patients (2016)

Type of publication:
Journal article

Author(s):
Sutcliffe R.P., Hollyman M., Hodson J., Bonney G., Vohra R.S., Griffiths E.A., Fenwick S., Elmasry M., Nunes Q., Kennedy D., Khan R.B., Khan M.A.S., Magee C.J., Jones S.M., Mason D., Parappally C.P., Mathur P., Saunders M., Jamel S., Haque S.U.L., Zafar S., Shiwani M.H., Samuel N., Dar F., Jackson A., Lovett B., Dindyal S., Winter H., Rahman S., Wheatley K., Nieto T., Ayaani S., Youssef H., Nijjar R.S., Watkin H., Naumann D., Emeshi S., Sarmah P.B., Lee K., Joji N., Heath J., Teasdale R.L., Weerasinghe C., Needham P.J., Welbourn H., Forster L., Finch D., Blazeby J.M., Robb W., McNair A.G.K., Hrycaiczuk A., Charalabopoulos A., Kadirkamanathan S., Tang C.-B., Jayanthi N.V.G., Noor N., Dobbins B., Cockbain A.J., Nilsen-Nunn A., de Siqueira J., Pellen M., Cowley J.B., Ho W.-M., Miu V., White T.J., Hodgkins K.A., Kinghorn A., Tutton M.G., Al-Abed Y.A., Menzies D., Ahmad A., Reed J., Monk D., Vitone L.J., Murtaza G., Joel A., Brennan S., Shier D., Zhang C., Yoganathan T., Robinson S.J., McCallum I.J.D., Jones M.J., Elsayed M., Tuck L., Wayman J., Aroori S., Kimble A., Bunting D.M., Hosie K.B., Fawole A.S., Basheer M., Dave R.V., Sarveswaran J., Jones E., Kendal C., Tilston M.P., Gough M., Wallace T., Singh S., Downing J., Mockford K.A., Issa E., Shah N., Chauhan N., Wilson T.R., Forouzanfar A., Wild J.R.L., Nofal E., Bunnell C., Madbak K., Rao S.T.V., Devoto L., Siddiqi N., Khawaja Z., Hewes J.C., Rodriguez D.U., Sen G., Carney K., Bartlett F., Rae D.M., Stevenson T.E.J., Sarvananthan K., Dwerryhouse S.J., Higgs S.M., Old O.J., Hardy T.J., Shah R., Hornby S.T., Keogh K., Frank L., Al-Akash M., Upchurch E.A., Frame R.J., Hughes M., Jelley C., Weaver S., Roy S., Sillo T.O., Galanopoulos G., Cuming T., Cunha P., Tayeh S., Kaptanis S., Heshaishi M., Eisawi A., Abayomi M., Ngu W.S., Fleming K., Bajwa D.S., Chitre V., Aryal K., Ferris P., Silva M., Lammy S., Mohamed S., Khawaja A., Ghazanfar M.A., Bellini M.I., Ebdewi H., Elshaer M., Gravante G., Drake B., Ogedegbe A., Mukherjee D., Arhi C., Giwa L., Iqbal N., Watson N.F., Aggarwal S.K., Orchard P., Villatoro E., Willson P.D., Mok K.W.J., Woodman T., Deguara J., Garcea G., Babu B.I., Dennison A.R., Malde D., Lloyd D., Slavin J.P., Jones R.P., Ballance L., Gerakopoulos S., Jambulingam P., Mansour S., Sakai N., Acharya V., Sadat M.M., Karim L., Larkin D., Amin K., Khan A., Law J., Jamdar S., Sampat K., O'shea K.M., Manu M., Asprou F.M., Malik N.S., Chang J., Johnstone M., Lewis M., Roberts G.P., Karavadra B., Photi E., Hewes J., Gould L., Rodriguez D., O'Reilly D.A., Rate A.J., Sekhar H., Henderson L.T., Starmer B.Z., Coe P.O., Tolofari S., Barrie J., Bashir G., Sloane J., Madanipour S., Halkias C., Trevatt A.E.J., Borowski D.W., Hornsby J., Courtney M.J., Virupaksha S., Seymour K., Robinson S., Hawkins H., Bawa S., Gallagher P.V., Reid A., Wood P., Finch J.G., Parmar J., Stirland E., Gardner-Thorpe J., Al-Muhktar A., Peterson M., Majeed A., Bajwa F.M., Martin J., Choy A., Tsang A., Pore N., Andrew D.R., Al-Khyatt W., Santosh Bhandari C.T., Chambers A., Subramanium D., Toh S.K.C., Carter N.C., Mercer S.J., Knight B., Vijay V., Alagaratnam S., Sinha S., Khan S., El-Hasani S.S., Hussain A.A., Bhattacharya V., Kansal N., Fasih T., Jackson C., Siddiqui M.N., Chishti I.A., Fordham I.J., Siddiqui Z., Bausbacher H., Geogloma I., Gurung K., Tsavellas G., Basynat P., Shrestha A.K., Basu S., Chhabra A., Harilingam M., Rabie M., Akhtar M., Kumar P., Jafferbhoy S.F., Hussain N., Raza S., Haque M., Alam I., Aseem R., Patel S., Asad M., Booth M.I., Ball W.R., Wood C.P.J., Pinho-Gomes A.C., Kausar A., Obeidallah M., Varghase J., Lodhia J., Bradley D., Rengifo C., Lindsay D., Gopalswamy S., Finlay I., Wardle S., Bullen N., Iftikhar S.Y., Awan A., Leeder P., Fusai G., Bond-Smith G., Psica A., Puri Y., Hou D., Noble F., Szentpali K., Broadhurst J., Date R., Hossack M.R., Goh Y.L., Turner P., Shetty V., *Riera M., *Macano C.A.W., *Sukha A., Preston S.R., Hoban J.R., Puntis D.J., Williams S.V., Krysztopik R., Kynaston J., Batt J., Doe M., Goscimski A., Jones G.H., Smith S.R., Hall C., Carty N., Ahmed J., Panteleimonitis S., Gunasekera R.T., Sheel A.R.G., Lennon H., Hindley C., Reddy M., Kenny R., Elkheir N., McGlone E.R., Rajaganeshan R., Hancorn K., Hargreaves A., Prasad R., Longbotham D.A., Vijayanand D., Wijetunga I., Ziprin P., Nicolay C.R., Yeldham G., Read E., Gossage J.A., Rolph R.C., Ebied H., Phull M., Khan M.A., Popplewell M., Kyriakidis D., Hussain A., Henley N., Packer J.R., Derbyshire L., Porter J., Appleton S., Farouk M., Basra M., Jennings N.A., Ali S., Kanakala V., Ali H., Lane R., Dickson-Lowe R., Zarsadias P., Mirza D., Puig S., Al Amari K., Vijayan D., Sutcliffe R., Marudanayagam R., Hamady Z., Prasad A.R., Patel A., Durkin D., Kaur P., Bowen L., Byrne J.P., Pearson K.L., Delisle T.G., Davies J., Tomlinson M.A., Johnpulle M.A., Slawinski C., Macdonald A., Nicholson J., Newton K., Mbuvi J., Farooq A., Mothe B.S., Zafrani Z., Brett D., Francombe J., Spreadborough P., Barnes J., Cheung M., Al-Bahrani A.Z., Preziosi G., Urbonas T., Alberts J., Mallik M., Patel K., Segaran A., Doulias T., Sufi P.A., Yao C., Pollock S., Manzelli A., Wajed S., Kourkulos M., Pezzuto R., Wadley M., Hamilton E., Jaunoo S., Padwick R., Sayegh M., Newton R.C., Farag S.F., Hebbar M., Spearman J., Hamdan M.F., D'Costa C., Blane C., Giles M., Peter M.B., Hirst N.A., Hossain T., Pannu A., El-Dhuwaib Y., Morrison T.E.M., Taylor G.W., Thompson R.L.E., McCune K., Loughlin P., Lawther R., Byrnes C.K., Simpson D.J., Mawhinney A., Warren C., McKay D., McIlmunn C., Martin S., MacArtney M., Diamond T., Davey P., Jones C., Clements J.M., Digney R., Chan W.M., McCain S., Gull S., Janeczko A., Dorrian E., Harris A., Dawson S., Johnston D., McAree B., Ghareeb E., Thomas G., Connelly M., McKenzie S., Cieplucha K., Spence G., Campbell W., Hooks G., Bradley N., Cassidy J.T., Boland M., Burke P., Nally D.M., Hill A.D.K., Khogali E., Shabo W., Iskandar E., McEntee G.P., O'Neill M.A., Peirce C., Lyons E.M., O'Sullivan A.W., Thakkar R., Carroll P., Ivanovski I., Balfe P., Lee M., Winter D.C., Kelly M.E., Hoti E., Maguire D., Karunakaran P., Geoghegan J.G., Martin S.T., Cross K.S., Cooke F., Zeeshan S., Murphy J.O., Mealy K., Mohan H.M., Nedujchelyn Y., Ullah M.F., Ahmed I., Giovinazzo F., Milburn J., Prince S., Brooke E., Buchan J., Khalil A.M., Vaughan E.M., Ramage M.I., Aldridge R.C., Gibson S., Nicholson G.A., Vass D.G., Grant A.J., Holroyd D.J., Jones A., Sutton C.M.L.R., O'Dwyer P., Nilsson F., Weber B., Williamson T.K., Lalla K., Bryant A., Carter R., Forrest C.R., Hunter D.I., Nassar A.H., Orizu M.N., Knight K., Qandeel H., Suttie S., Belding R., McClarey A., Boyd A.T., Guthrie G.J.K., Lim P.J., Luhmann A., Watson A.J.M., Richards C.H., Nicol L., Madurska M., Harrison E., Boyce K.M., Roebuck A., Ferguson G., Pati P., Wilson M.S.J., Dalgaty F., Fothergill L., Driscoll P.J., Mozolowski K.L., Banwell V., Bennett S.P., Rogers P.N., Skelly B.L., Rutherford C.L., Mirza A.K., Lazim T., Lim H.C.C., Duke D., Ahmed T., Beasley W.D., Wilkinson M.D., Maharaj G., Malcolm C., Brown T.H., Shingler G.M., Mowbray N., Radwan R., Morcous P., Wood S., Kadhim A., Stewart D.J., Baker A.L., Tanner N., Shenoy H.

Citation:
HPB, November 2016, vol./is. 18/11(922-928)

Abstract:
Background Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice. Patients and methods Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach. Results Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p < 0.001), indication for surgery (p < 0.001), ASA (p < 0.001), thick-walled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p < 0.001), and a score >6 identified patients at high risk of conversion (7.1% vs. 1.2%). Conclusion This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy.

Recruitment, response rates and characteristics of 5511 people enrolled in a prospective clinical cohort study: head and neck 5000 (2016)

Type of publication:
Journal article

Author(s):
Ness A.R., Waylen A., Hurley K., Jeffreys M., Penfold C., Pring M., Leary S.D., Allmark C., Toms S., Ring S., Peters T.J., Hollingworth W., Worthington H., Fisher S., Rogers S.N., Thomas S.J., Rogers S., Thiruchelvam J.K., Abdelkader M., Anari S., Dykerand K., McCaul J., Benson R., Stewart S., Lester J., Hamidand A., Lamont A., Fresco L., Mehanna H., Lester S., Cogill G., Roy A., Bisase B., Balfour A., Evans A., Gollins S., Conway D., Hall C., Gunasekaran S.P., Lees L., Lowe R., England J., Scrase C., Wight R., Sen M., Doyle M., Moule R., Rowell N., Beaumont-Jewell D., Loo H.W., Goodchild K., Jankowska P., Paleri V., Casasola R., Roques T., Tierney P., Dyson P., Andrade G., Tatla T., Christian J., Winter S., Baldwin A., Davies J., King E., Barnes D., Repanos C., Kim D., Richards S., Dallas N., McAlister K., Hwang D., Berry S., Cole N., Moss L., Palaniappan N., Homer J., Nutting C., Siva M., *Hari C. , Wood K., Simcock R., Waldron J., Hyde N., P Gunasekaran S., Hamid A., Foran B., Ahmed I., Gahir D., O'Hara J., Carr R., Forster M., Sheehan T., Thomas S., Evans M., Wagstaff L., Mano J., Brammer C., Tyler J., Coatesworth A.

Citation:
Clinical Otolaryngology, December 2016, vol./is. 41/6(804-809)

HEART UK statement on the management of homozygous familialhypercholesterolaemia in the United Kingdom (2016)

Type of publication:
Journal article

Author(s):
France M., Rees A., Datta D., Thompson G., *Capps N., Ferns G., Ramaswami U., Seed M., Neely D., Cramb R., Shoulders C., Barbir M., Pottle A., Eatough R., Martin S., Bayly G., Simpson B., Halcox J., Edwards R., Main L., Payne J., Soran H.

Citation:
Atherosclerosis, December 2016, vol./is. 255/(128-139)

Abstract:
This consensus statement addresses the current three main modalities of treatment of homozygous familial hypercholesterolaemia (HoFH): pharmacotherapy, lipoprotein (Lp) apheresis and liver transplantation. HoFH may cause very premature atheromatous arterial disease and death, despite treatment with Lp apheresis combined with statin, ezetimibe and bile acid sequestrants. Two new classes of drug, effective in lowering cholesterol in HoFH, are now licensed in the United Kingdom. Lomitapide is restricted to use in HoFH but, may cause fatty liver and is very expensive. PCSK9 inhibitors are quite effective in receptor defective HoFH, are safe and are less expensive. Lower treatment targets for lipid lowering in HoFH, in line with those for the general FH population, have been proposed to improve cardiovascular outcomes. HEART UK presents a strategy combining Lp apheresis with pharmacological treatment to achieve these targets in the United Kingdom (UK). Improved provision of Lp apheresis by use of existing infrastructure for extracorporeal treatments such as renal dialysis is promoted. The clinical management of adults and children with HoFH including advice on pregnancy and contraception are addressed. A premise of the HEART UK strategy is that the risk of early use of drug treatments beyond their licensed age restriction may be balanced against risks of liver transplantation or ineffective treatment in severely affected patients. This may be of interest beyond the UK.

Are local, speciality specific career days beneficial for medical students and foundation doctors? (2016)

Type of publication:
Conference abstract

Author(s):
*Barker V., *Godden M., *Jones C., *Panikkar J.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, December 2016, vol./is. 123/(6-7)

Abstract:
The Health Education Midlands holds an annual career day for all specialities to attend, allowing all medical students and foundation doctors to explore different specialities within the local area. The Royal College of Obstetricians and Gynaecologists also provide a careers day, for anyone to attend. Both of these are useful resources however do have some limitations due to number of delegates attending and also number of specialities in attendance. Our local obstetrics and gynaecology school held a pilot, local, careers days to allow any medical student from 4th year and above and any foundation doctor within the region, the opportunity to attend. The day consisted of a variety informal presentations about the 'day in a life' and was given by a variety of trainees across the school. The deputy head of school also came and provided more specific information on training pathways. The day also included several workshops covering resilience, CV building, and practical skills. The informal nature meant that the delegates could feel free to ask any of us any questions they wish to do so during the process. The delegates were asked to provide feedback at the end of the day. We had a total of 42 delegates, of which the majority found the day useful, we did not receive any negative feedback. We hope that the delegates can use this experience when deciding on future careers. We are intending on repeating the careers day again.

Link to full-text: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14447/epdf

Obstacles to consent for intravenous rtPAin acute stroke (clinical audit and survey) (2016)

Type of publication:
Conference abstract

Author(s):
*Alamgir M., *Srinivasan M., *Ghani U.

Citation:
Cerebrovascular Diseases, May 2016, Vol. 41, Supplement 1, p.285-286

Abstract:
Introduction: Intravenous thrombolysis with rTPA is the standard of care for the treatment of acute ischaemic stroke within 3 hrs (up to 4.5 in suitable Pt) after stroke onset. Even with clear evidence of benefit there is increased risk of harm . Due to complex risk & benefit aspects of the treatment the current guidance recommends consent should be obtained for intravenous thrombolysis whenever possible. Our objective was to review the current practice in documentation of consent and also identify the factors which contribute in fauilu-re to obtain consnet Method: We have randomly selected 25 Patient's notes those were admitted from November 2014 to May 2015 and looked for the completed consent form or documentation elsewhere. We have also conducted a survey among Stroke Consultants and medical registrars (who are involved in administration of intravenous thrombolysis) to identify the reasons responsible for failure to obtain consent in acute setting. Results: The documentation of consent was noted to be very poor (either on consent form or documentation elsewhere in notes). Consent form was completed only in 27% cases and there was no clear documentation of reasons for not obtaining consent in the rest. Survey results showed that the only 40% were aware of the consent form in pathway. Reasons of not obtaining consent were , Time pressure = 40%, Patient factors = 40, Ignorance of statistics( Not sure about actual statistics) = 20 %. Conclusion: We have recommended that the use of a consent form with visual illustrations of statistics of risks & benefits to make consent process easier to understand for patients & save time in acute settings. Alternatively suggested that If patient does not have capacity for consent then there should be every effort made to involve the family and next of kin in decision making process (Figure Presented).

Link to more details or full-text: http://misc.karger.com/products/CED_2016_041_S1/index.html

A national colposcopy survey comparing destructive versus excisional treatment for CIN (2016)

Type of publication:
Conference abstract

Author(s):
Parry-Smith W., *Papoutsis D., Parris D., *Panikkar J., Redman C., *Underwood M.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, June 2016, vol./is. 123/(99)

Abstract:
Introduction Women found to have high grade CIN should be offered either ablative treatment or large loop excision of the transformation zone with appropriate biopsy. Objective 1) To learn if a trial of ablative versus excisional treatment would be supported by fellow colposcopists in the UK 2) To investigate the current practice amongst colposcopists with regards to ablative treatment for high grade CIN 3) To gain an understanding of aspects of practice such as use of local anaesthetic during punch biopsies Methods An electronic questionnaire was sent to all registered colposcopists in the United Kingdom (total = 1677). Of these, 325 responded (19%). The study was granted ethical approval by the council of the British Society for Colposcopy and Cervical Pathology (BSCCP). Results The majority of colposcopists n = 248 (76%) felt that a study investigating the morbidity and Test of Cure outcomes comparing excisional and destructive treatments was needed. A reduced complication and morbidity rate would be the greatest factor to encourage colposcopists to use destructive treatments more often n = 250 (76.92%). If a destructive treatment were found to have a significantly reduced complication, morbidity, and equal or higher patient satisfaction rate during the procedure, but resulted in a slightly higher need for further treatment 5%, this was acceptable to n = 140 (43.1%) of those surveyed. However, a further treatment rate of 2.5% was acceptable to n = 196 (60.1%). The majority n = 182 (56%) of colposcopists did not perform destructive treatments for high grade disease; For those who did not perform destructive treatments the main reason was that they were not aware of sufficient evidence for its use n = 98 (30.2%) and had no experience nor training n = 33 (10.25%). Cold coagulation was the most common destructive treatment n = 100 (31%) that colposcopists could perform, with diathermy n = 70 (22%), laser n = 11 (3.4%) and cryotherapy n = 10 (3.1%) being less prevalent. The majority of colposcopists took two punch biopsies per patient n = 190 (58.5%), with only n = 45 (13.8%) taking three or more biopsies. Silver nitrate was the most favoured haemostatic technique following punch biopsy n = 217 (66.7%), with n = 269 (87.1%) using no local analgesia. Conclusion A study investigating morbidity and Test of Cure of excisional compared with destructive treatments for high grade CIN would be supported by most participating colposcopists. Variation in practice regarding both treatment and diagnosis exists. This has quality assurance implications for a standardised national screening programme.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201606002-00174&LSLINK=80&D=ovft

Haematocolpos. A 20-year review of cases at a District General Hospital (2016)

Type of publication:
Conference abstract

Author(s):
*Oates S.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, June 2016, vol./is. 123/(24)

Abstract:
Introduction Paediatric and Adolescent care is now more structured within the gynaecology department and will often be undertaken by only one or two individuals. It would be useful to know the outcome after uncommon procedures to provide advice and reassurance to both the girls and their parents. Haematocolpos is a simple adolescent surgical intervention although the underlying pathology can be variable. Methods This was a retrospective study of 23 cases of haematocolpos identified using ICD codes, theatre records and theatre diaries at the Shrewsbury and Telford Hospitals trust over a 20 year period. More than half of the cases had been managed by the author. Results The age range of the girls was 11-17 years and those presenting with delayed menarche were aged 16 or 17 years at diagnosis. The commonest symptom was pain in 17 (74%) and then delayed menarche in 3 (13%) and urinary retention or difficult micturition in 3 (13%). There were three cases of Uterus Didelyphys and in these cases the girls had had menarche 1, 2 or 3 years before. Two cases of Transverse Vaginal Septum were identified and these girls required more extensive and repeated surgery to correct their problem following referral to a tertiary centre. The follow-up period for these patients is between 6 months to 20 years. Of the 23 cases identified 4 patients were lost to follow-up but all the others remain local. Five (22%) have gone on to successful pregnancies without difficulty. A further two cases have tried for pregnancies but one lady is awaiting a kidney transplant due to chronic renal failure and the other has a partner with sperm dysfunction and her BMI precludes her from infertility treatment at present. The remaining 12 do not appear to have any contact with maternity services yet or have a referral for infertility issues. There is no evidence that any of these women have endometriosis although two have had further surgery to open up their tight hymen and two have had vaginal dilators to stretch the hymen. Conclusion The management of heamatocolpos is relatively simple but follow-up of the cases highlights the variable out comes.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201606002-00037&LSLINK=80&D=ovft

The incidence of and risk factors for a repeat obstetrical anal sphincter injury (OASIS) in the vaginal birth subsequent to a first episode of OASIS (2016)

Type of publication:
Conference abstract

Author(s):
*Papoutsis D., *Henderson K., *Tapp A., *Qadri Z.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, June 2016, vol./is. 123/(52)

Abstract:
Objective The aim of our study was to identify the incidence of and the risk factors for a repeat OASIS in the subsequent vaginal birth of a cohort of primiparous women who sustained an OASIS in their first vaginal delivery. Methods Retrospective collection of data from the obstetric database of our hospital for women having had singleton cephalic presentation vaginal deliveries between 2007 and 2015. Results We identified 603 primiparous women who sustained a first episode of OASIS in their first vaginal delivery (3a tear: 43%, 3b tear: 38.6%, 3c tear: 13.1%, 4th degree tear: 5.3%). This represents an incidence of first OASIS in the population of primiparous women delivering over the same time period of 5.4% (603/11 191). In the subgroup of women with a first episode of OASIS, the mean age was 27.8 years (SD = 5.7), 30.8% had an induction of labour and 38% had an instrumental delivery. Of this initial cohort of women, 243 (40.2%) had a subsequent pregnancy. In this subgroup, 190 (78.1%) had a vaginal delivery, 13 (5.4%) had an emergency CS delivery while in labour and 40 (16.5%) had an elective CS delivery. In those that delivered vaginally, 16 women had a repeat OASIS thus representing an incidence of 8.4%. After adjusting for several confounding factors, it was found in multivariable analysis that risk factors independently associated with the risk of a repeat OASIS were the use of epidural analgesia and an episiotomy in the first delivery, and a short labour (<3 h) in the second delivery. The time interval between the two vaginal births was not associated with any increased risk of a repeat OASIS. Conclusion We have found that 8.4% of women sustained a repeat OASIS in a subsequent vaginal birth with this risk being associated with the presence of a short second labour and certain features from the first labour.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201606002-00085&LSLINK=80&D=ovft