Health-Related Quality of Life 24-36 Months After Vaginal Delivery with and Without Obstetric Anal Sphincter Injury: A Comparative Cohort Study.

INTRODUCTION AND HYPOTHESIS: Obstetric anal sphincter injury (OASI) is associated with pelvic floor dysfunction and long-term morbidity; however, its independent impact on global health-related quality of life (HRQoL) remains uncertain. We hypothesized that women with OASI would have a higher probability of impaired HRQoL than women without severe perineal trauma. METHODS: We conducted a retrospective comparative cohort study at a tertiary referral center in Cali, Colombia. All women with documented OASI grade III-IV identified from the institutional delivery registry (n = 60) were compared with randomly selected women without OASI from the same source population and time period (n = 60; 1:1 ratio). HRQoL was assessed 24-36 months postpartum using the validated Spanish version of the Short Form Health Survey questionnaire. Impaired HRQoL was defined as a Physical Component Summary (PCS) or Mental Component Summary (MCS) score below 50. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were estimated using multivariable logistic regression. RESULTS: Among the 120 women included, mean PCS and MCS scores were 47.6 ± 7.7 and 44.5 ± 9.3 respectively. In adjusted analyses, OASI was not independently associated with impaired physical HRQoL (adjusted OR 1.94, 95% CI 0.87-4.43) or impaired mental HRQoL (adjusted OR 1.54, 95% CI 0.64-3.73). Mestiza ethnicity was independently associated with impaired mental HRQoL (adjusted OR 4.68, 95% CI 1.47-16.60). CONCLUSIONS: In women evaluated 24-36 months after vaginal delivery, OASI was not independently associated with impaired physical or mental HRQoL. Broader social and contextual determinants appear to influence long-term postpartum quality of life more strongly than the perineal injury itself.