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O961 Maternal and perinatal outcome of pregnancies complicating severe renal impairment: A study of 38 pregnancies
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
victims and community study to characterize sexual violence for community response are recommended. O958 Barriers to acceptance of assisted reproductive techniques (ART) in Northern Nigeria. A single centre experience N. Umar1 , N. Khan, A. Ardo. 1 Federal Medical Centre, Azare, Bauchi State, Nigeria Objective: ART has come to stay as a means of treating infertility worldwide. However, in our Centre, it is virtually rejected by infertile couples. We therefore, decided to conduct a study to find reasons for such rejection. Materials and Methods: An open structured questioneer was administered to the infertile couples attending our Gynaecological Outpatient Unit over a period of 1-year (1st Jan – 31st December, 2008). The key was that if the only treatment option available is ART, will you accept it? The results were collated and analyzed using EPI Info version 6. Result: 4166 Gynaecological patients were seen during the study period, out of which 875 were infertile. Therefore, infertility constitutes 21% of all gynaecological consultations. The mean age of the clients was 27 SD 3 years. Parity ranges from 0 to 4 with a maen of 2. A significant number 858 (98.0%) were against ART. Their reasons include religious and cultural beliefs (87%). Waiting for more time (9%). Cost (3%). Not convince about the success of ART (1%). Those that rejected ART because of religous and cultural beliefs gave the following as their reasons. ART childrens are not biologically theirs (46%). children not concieved through normal coitus are abnormal (40%), religous reasons (12%), ART children would be rejected by the society (2%). Conclusion: Unlike in several Centres, where cost is a major barrieer. In our Centre, Religious and Cultural beliefs are more important consideration. Counselling should provide a key for addressing these barriers for the population to reap the advances offerred by science in solving infertility problems. O959 An exploration of perceptions and attitudes influencing decision making on health care seeking and acceptability of treatment for incomplete abortion in a low-resource rural setting R. Unkels1 , M. Felix2 , A. Litwe2 , A. Pegwa3 , N. Mmuni3 , A. Hamisi3 , A. Mohamed4 , H. Van Beekhuizen5 . 1 Department of Gynaecology and Obstetrics, DIAKO Hospital Bremen, Germany, 2 PEMWA NGO, Lindi, Tanzania, 3 Sokoine Regional Hospital, Lindi, Tanzania, 4 Regional Medical Office, Lindi Region, Tanzania, 5 Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands Objectives: Although incomplete abortion is a major problem, little is known about acceptability of comprehensive post abortion care (CPAC) and the factors influencing utilization. The objective of this study was to explore contextual factors of decision-making on care seeking and acceptability of two methods of CPAC. Methods: A qualitative cross-sectional study was conducted in South Tanzania. In-depth interviews were carried out in 19 patients and 13 family members after treatment for incomplete abortion. Interviews were tape-recorded, transcribed, subjected to thematic analysis with coding for key issues which were grouped under framework concepts. Results: Important factors for acceptability of treatment were quick diagnosis and treatment regardless the method. This was related to the difficult economic situation cited by most participants. Transport took up most of the budget for treatment and lack of transparency concerning costs of treatment made women reluctant to seek treatment early. This delay caused complications. Conclusions: Acceptability of treatment is linked to health system management issues, not to the choice of method. Clinicians should be aware of those issues which may negatively influence treatment. Research on funding of transport in reproductive health should be
conducted to investigate if this could enable women to access care. A clear policy on diagnostic and treatment standards and costs involved should be announced publicly to support women to seek treatment early with minimal costs and to reduce the opportunity for unoffical payments. O960 Caesarean Section at full dilatation – Results from a three year audit J. Unterscheider, M. McMenamin, I. Abdelrahim, F. Cullinane. University Hospital Galway, Ireland Introduction: Caesarean section (CS) performed during the second stage of labour is associated with increased maternal and neonatal morbidity and mortality. A three year audit was conducted of women who had a CS at full dilatation between 1 January 2006 and 31 December 2008 at University Hospital Galway (UHG), a tertiary referral centre in Ireland with over 3600 births per annum. Aims and Methods: The aims of this audit were to determine (i) the rate of CS during the second stage of labour (ii) the indications for the CS and (iii) the associated maternal and neonatal morbidity. Women who underwent a CS at full dilatation were identified from the hospital database and their medical records were reviewed. Results: 2798/10,203 women (27.4%) were delivered by CS during the study period. 135 CS (4.8%) were performed at full dilatation. The overall CS rate during the second stage of labour was 1.3% (135/10,203) with an increase from 0.9% (30/3224) in 2006 to 1.2% (39/3367) in 2007 to 1.8% (66/3612) in 2008. The majority of women (77%) were nulliparous, in spontaneous labour (62%) at term. In 2006 and 2007 a Consultant Obstetrician was present at the delivery in 40.5% of cases. 77 (57%) of women were delivered by CS without an attempt at an instrumental delivery. One third of women had a primary PPH over 500 mls. One woman had a massive haemorrhage due to iliac vein trauma at CS requiring ICU admission. Conclusions: There was a worrying increase in the rate of CS at full dilatation from 0.9% in 2006 to 1.8% in 2008. One potential way to address this problem is to have assessment by a Consultant Obstetrician. This provides ongoing training, supervision and formal instruction of Registrars to ensure correct assessment, skilled delivery and a safe outcome for both mother and baby. O961 Maternal and perinatal outcome of pregnancies complicating severe renal impairment: A study of 38 pregnancies J. Unuigbe Objective: To assess the maternal and perinatal outcome of pregnancy among patients with chronic renal failure (CRF) with severely compromised renal function, and pregnant renal transplant recipients. Method: The study was conducted in a tertiary hospital in the southern (Gizan) region of Saudi Arabia and consisted of 38 pregnancies among thirty women with CRF, including nine women with end-stage renal disease (ESRD), and five renal transplant recipients. Renal functional compromise was determined by assessing the serial mean values of serum urea and creatinine, proteinuria, and clinical profiles (including blood pressure) of subjects during pregnancy, delivery, and puerperium. Maternal and perinatal complications were assessed. Results: The severity of renal compromise as reflected by high creatinine and urea values was striking. Proteinuria featured in 77.1 percent of patients, including all the women with ESRD. Maternal complications included hypertension, infections, anaemia and preeclampsia. Significant perinatal complications included intrauterine growth restriction, preterm delivery, notably among dialysis patients. Maternal and perinatal complications were relatively few and mild among renal transplant recipients. The overall perinatal mortality rate was high (257 per thousand),
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
reflecting the patients’ degree of renal compromise. There was no statistically significant renal functional deterioration at the end of pregnancy or six weeks postpartum. Conclusion: Pregnant women with CFR and severely compromised renal functions had significantly high rates of medical and obstetric complications resulting in significantly adverse perinatal outcome. O962 Factors influencing VBAC outcome S. Upendram1 , S. Al-Rubaish. 1 King Abdul Aziz Medical City Introduction: Beginning in the mid-1980s, when trial of labor and vaginal delivery after a low transverse cesarean delivery were shown to be reasonably safe, pregnant women (and their obstetricians) have been encouraged in most cases to attempt a vaginal birth after cesarean delivery (VBAC). Success rates vary but average approximately 60–80%. A number of studies have found that circumstances surrounding the first cesarean delivery strongly influence the likelihood of successful VBAC. There have been several reports of increased complications, prolonged hospital stays, and increased costs after failed trial of labor, although overall, trial of labor appears to be less costly than elective repeat cesarean delivery. This has led to identify those patients who are at high risk for failed trial of labor. The population in the Middle East is one which believes in large family size and with no tubal ligation unless it is life threatening. Therefore it is important that the woman gets her maximum chance to deliver vaginally, in order to avoid the risks that may be associated with multiple cesarean scars. Objective: To study the factors effecting the success of vaginal birth after cesarean delivery (VBAC) and to possibly formulate a scoring system, thereby to help the patient to make a right choice regarding the mode of delivery, thus ensuring to some extent that the mother and fetus have a better outcome. Design and Methodology: The study conducted in King Abdul Aziz Medical City, RIYADH, Kingdom of Saudi-Arabia. A retrospective Study to look into the factors which are likely to affect the success of vaginal birth following a cesarean section. Charts of patients who had a trial of scar between March-2007 and February-2008 were reviewed. The various factors affecting their outcome are tabulated and analyzed. Results: We have found a higher incidence of failure of trial of labour in patients with high BMI, Previous no vaginal births, cesarean section after 7–8 cm dilated cervices, previous cesarean for failure to progress, fetus >3.5 kg, and a male fetus. Highest success rates were in patients with previous successful VBAC. Conclusion: Having identified the factors in our population that are associated with high chances of failure of a VBAC, we find it easier to counsel our population about the success rates of VBACand risks and benefits and thereby are able to provide them with the study results. Our plan in the near future is to formulate a scoring system which might give us a score beyond which the VBAC would be discouraged. O963 Can visual inspection of cervix after application of acetic acid (VIA) replace cytology as a single screening test for cervical cancer in developing countries M. Vachhani1 , A. Virkud2 , P. Gujrathi2 . 1 Burnley General Hospital (East lancashire Hospitals NHS Trust) UK, 2 K.B. Bhabha Municipal General Hospital, Mumbai, India Introduction: An estimated 470,000 new cases of cervical cancer are diagnosed each year globally, and 80% of these occur in developing countries. 126000 new cases and 71,000 deaths due to cervical cancer occur each year in India. More than 80% of cases are diagnosed at an advanced clinical stage. Cytology based screening programmes do not exists in India due to lack of funds, trained personnel and limited infrastructure.
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Objective: To evaluate if VIA could be used as an alternative to cytology as a screening method for diagnosis of pre-invasive lesion. Material and Method: 403 (69%) women were referred from gynaec OPD, 166 (29%) were self referred with no symptoms, and 11 (2%) healthy women were referred from family planning clinic. The Concurrent examination by cytology and VIA was carried out by an accredited Colposcopist and the gynae residents, on 580 women. All women were investigated with colposcopy and biopsies were taken from 211 women who had Colposcopic abnormality. The reference standard for final disease status was histologically confirmed CIN. Results: 76 (13%) women were diagnosed with histologically proved CIN. 54 (9%) were low grade CIN and 22 (4%) were diagnosed as high grade CIN. 9 women were diagnosed with invasive cervical cancer and were referred to oncology unit. The sensitivity of VIA to diagnose CIN was 92% and specificity was 69% while sensitivity of cytology to diagnose CIN was 61% and specificity was 82%. Conclusion: VIA is cost effective, reasonably accurate, and can be used as an alternative to cytology in screening programmes in a resource restricted settings. O964 Healing and functional outcomes after obstetric anal sphincter injury in HIV-positive vs HIV-negative patients J. Van den Berg, S. Jeffery Aim: To determine whether HIV-positive patients have a longer time to healing, more complications and poorer functional outcomes after Obstetric Anal Sphincter Injury (OASI) than an HIVnegative control group. Setting: Secondary and Tertiary hospitals of the Western Cape Peninsula Maternal and Neonatal Service. Methods: This was a prospective cohort study of all women with acute OASI delivering between September 2008 and July 2009. Initial assessment immediately following delivery included demographics, details of the perineal repair and pre-pregnancy anal, urinary and sexual function. This included a pre-pregnancy perineal pain score, a Wexner Score for anal incontinence, an assessment of urinary symptoms the Abbreviated Sexual Function Questionnaire (ASFQ). Women were followed up six weeks later, once again assessing them for anal, urinary and sexual function as well as perineal pain. All women were examined with particular attention to the integrity of the perineum and anal sphincter repair. Results: 68 women were enrolled including 54 HIV-negative and 14 HIV-positive women. There were no differences between the two groups with regards to severity of OASI. 36 women attended follow-up including 28 HIV-negative (78%) and 8 HIVpositive (22%). Using Wexner scores (where higher scores indicate a greater impact) at six weeks post OASI, HIV-positive women were significantly more likely to experience solid stool incontinence (mean Wexner Score 0.88 vs 0.11; p = 0.041), as well as a negative lifestyle impact (mean Wexner Score 0.88 vs 0.07; p = 0.007) compared to HIV-negative women with OASI. Of interest, postpartum de novo stress urinary incontinence at six weeks was more common in HIV-positive women (37.5% vs 0%; p = 0.0078). There were no significant differences in healing, infection, anal sphincter integrity or tone between the two groups at follow-up. Conclusion: HIV-positive patients experience significantly more solid stool incontinence and have poorer lifestyle impact scores after OASI at six weeks postpartum. HIV-positive women also appear to experience more de novo postpartum stress urinary incontinence than HIV-negative controls. Our study suggests that HIV-positive women may have poorer postpartum muscle function than HIV-negative women and this needs to be addressed by further studies.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
victims and community study to characterize sexual violence for community response are recommended. O958 Barriers to acceptance of assisted reproductive techniques (ART) in Northern Nigeria. A single centre experience N. Umar1 , N. Khan, A. Ardo. 1 Federal Medical Centre, Azare, Bauchi State, Nigeria Objective: ART has come to stay as a means of treating infertility worldwide. However, in our Centre, it is virtually rejected by infertile couples. We therefore, decided to conduct a study to find reasons for such rejection. Materials and Methods: An open structured questioneer was administered to the infertile couples attending our Gynaecological Outpatient Unit over a period of 1-year (1st Jan – 31st December, 2008). The key was that if the only treatment option available is ART, will you accept it? The results were collated and analyzed using EPI Info version 6. Result: 4166 Gynaecological patients were seen during the study period, out of which 875 were infertile. Therefore, infertility constitutes 21% of all gynaecological consultations. The mean age of the clients was 27 SD 3 years. Parity ranges from 0 to 4 with a maen of 2. A significant number 858 (98.0%) were against ART. Their reasons include religious and cultural beliefs (87%). Waiting for more time (9%). Cost (3%). Not convince about the success of ART (1%). Those that rejected ART because of religous and cultural beliefs gave the following as their reasons. ART childrens are not biologically theirs (46%). children not concieved through normal coitus are abnormal (40%), religous reasons (12%), ART children would be rejected by the society (2%). Conclusion: Unlike in several Centres, where cost is a major barrieer. In our Centre, Religious and Cultural beliefs are more important consideration. Counselling should provide a key for addressing these barriers for the population to reap the advances offerred by science in solving infertility problems. O959 An exploration of perceptions and attitudes influencing decision making on health care seeking and acceptability of treatment for incomplete abortion in a low-resource rural setting R. Unkels1 , M. Felix2 , A. Litwe2 , A. Pegwa3 , N. Mmuni3 , A. Hamisi3 , A. Mohamed4 , H. Van Beekhuizen5 . 1 Department of Gynaecology and Obstetrics, DIAKO Hospital Bremen, Germany, 2 PEMWA NGO, Lindi, Tanzania, 3 Sokoine Regional Hospital, Lindi, Tanzania, 4 Regional Medical Office, Lindi Region, Tanzania, 5 Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands Objectives: Although incomplete abortion is a major problem, little is known about acceptability of comprehensive post abortion care (CPAC) and the factors influencing utilization. The objective of this study was to explore contextual factors of decision-making on care seeking and acceptability of two methods of CPAC. Methods: A qualitative cross-sectional study was conducted in South Tanzania. In-depth interviews were carried out in 19 patients and 13 family members after treatment for incomplete abortion. Interviews were tape-recorded, transcribed, subjected to thematic analysis with coding for key issues which were grouped under framework concepts. Results: Important factors for acceptability of treatment were quick diagnosis and treatment regardless the method. This was related to the difficult economic situation cited by most participants. Transport took up most of the budget for treatment and lack of transparency concerning costs of treatment made women reluctant to seek treatment early. This delay caused complications. Conclusions: Acceptability of treatment is linked to health system management issues, not to the choice of method. Clinicians should be aware of those issues which may negatively influence treatment. Research on funding of transport in reproductive health should be
conducted to investigate if this could enable women to access care. A clear policy on diagnostic and treatment standards and costs involved should be announced publicly to support women to seek treatment early with minimal costs and to reduce the opportunity for unoffical payments. O960 Caesarean Section at full dilatation – Results from a three year audit J. Unterscheider, M. McMenamin, I. Abdelrahim, F. Cullinane. University Hospital Galway, Ireland Introduction: Caesarean section (CS) performed during the second stage of labour is associated with increased maternal and neonatal morbidity and mortality. A three year audit was conducted of women who had a CS at full dilatation between 1 January 2006 and 31 December 2008 at University Hospital Galway (UHG), a tertiary referral centre in Ireland with over 3600 births per annum. Aims and Methods: The aims of this audit were to determine (i) the rate of CS during the second stage of labour (ii) the indications for the CS and (iii) the associated maternal and neonatal morbidity. Women who underwent a CS at full dilatation were identified from the hospital database and their medical records were reviewed. Results: 2798/10,203 women (27.4%) were delivered by CS during the study period. 135 CS (4.8%) were performed at full dilatation. The overall CS rate during the second stage of labour was 1.3% (135/10,203) with an increase from 0.9% (30/3224) in 2006 to 1.2% (39/3367) in 2007 to 1.8% (66/3612) in 2008. The majority of women (77%) were nulliparous, in spontaneous labour (62%) at term. In 2006 and 2007 a Consultant Obstetrician was present at the delivery in 40.5% of cases. 77 (57%) of women were delivered by CS without an attempt at an instrumental delivery. One third of women had a primary PPH over 500 mls. One woman had a massive haemorrhage due to iliac vein trauma at CS requiring ICU admission. Conclusions: There was a worrying increase in the rate of CS at full dilatation from 0.9% in 2006 to 1.8% in 2008. One potential way to address this problem is to have assessment by a Consultant Obstetrician. This provides ongoing training, supervision and formal instruction of Registrars to ensure correct assessment, skilled delivery and a safe outcome for both mother and baby. O961 Maternal and perinatal outcome of pregnancies complicating severe renal impairment: A study of 38 pregnancies J. Unuigbe Objective: To assess the maternal and perinatal outcome of pregnancy among patients with chronic renal failure (CRF) with severely compromised renal function, and pregnant renal transplant recipients. Method: The study was conducted in a tertiary hospital in the southern (Gizan) region of Saudi Arabia and consisted of 38 pregnancies among thirty women with CRF, including nine women with end-stage renal disease (ESRD), and five renal transplant recipients. Renal functional compromise was determined by assessing the serial mean values of serum urea and creatinine, proteinuria, and clinical profiles (including blood pressure) of subjects during pregnancy, delivery, and puerperium. Maternal and perinatal complications were assessed. Results: The severity of renal compromise as reflected by high creatinine and urea values was striking. Proteinuria featured in 77.1 percent of patients, including all the women with ESRD. Maternal complications included hypertension, infections, anaemia and preeclampsia. Significant perinatal complications included intrauterine growth restriction, preterm delivery, notably among dialysis patients. Maternal and perinatal complications were relatively few and mild among renal transplant recipients. The overall perinatal mortality rate was high (257 per thousand),
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
reflecting the patients’ degree of renal compromise. There was no statistically significant renal functional deterioration at the end of pregnancy or six weeks postpartum. Conclusion: Pregnant women with CFR and severely compromised renal functions had significantly high rates of medical and obstetric complications resulting in significantly adverse perinatal outcome. O962 Factors influencing VBAC outcome S. Upendram1 , S. Al-Rubaish. 1 King Abdul Aziz Medical City Introduction: Beginning in the mid-1980s, when trial of labor and vaginal delivery after a low transverse cesarean delivery were shown to be reasonably safe, pregnant women (and their obstetricians) have been encouraged in most cases to attempt a vaginal birth after cesarean delivery (VBAC). Success rates vary but average approximately 60–80%. A number of studies have found that circumstances surrounding the first cesarean delivery strongly influence the likelihood of successful VBAC. There have been several reports of increased complications, prolonged hospital stays, and increased costs after failed trial of labor, although overall, trial of labor appears to be less costly than elective repeat cesarean delivery. This has led to identify those patients who are at high risk for failed trial of labor. The population in the Middle East is one which believes in large family size and with no tubal ligation unless it is life threatening. Therefore it is important that the woman gets her maximum chance to deliver vaginally, in order to avoid the risks that may be associated with multiple cesarean scars. Objective: To study the factors effecting the success of vaginal birth after cesarean delivery (VBAC) and to possibly formulate a scoring system, thereby to help the patient to make a right choice regarding the mode of delivery, thus ensuring to some extent that the mother and fetus have a better outcome. Design and Methodology: The study conducted in King Abdul Aziz Medical City, RIYADH, Kingdom of Saudi-Arabia. A retrospective Study to look into the factors which are likely to affect the success of vaginal birth following a cesarean section. Charts of patients who had a trial of scar between March-2007 and February-2008 were reviewed. The various factors affecting their outcome are tabulated and analyzed. Results: We have found a higher incidence of failure of trial of labour in patients with high BMI, Previous no vaginal births, cesarean section after 7–8 cm dilated cervices, previous cesarean for failure to progress, fetus >3.5 kg, and a male fetus. Highest success rates were in patients with previous successful VBAC. Conclusion: Having identified the factors in our population that are associated with high chances of failure of a VBAC, we find it easier to counsel our population about the success rates of VBACand risks and benefits and thereby are able to provide them with the study results. Our plan in the near future is to formulate a scoring system which might give us a score beyond which the VBAC would be discouraged. O963 Can visual inspection of cervix after application of acetic acid (VIA) replace cytology as a single screening test for cervical cancer in developing countries M. Vachhani1 , A. Virkud2 , P. Gujrathi2 . 1 Burnley General Hospital (East lancashire Hospitals NHS Trust) UK, 2 K.B. Bhabha Municipal General Hospital, Mumbai, India Introduction: An estimated 470,000 new cases of cervical cancer are diagnosed each year globally, and 80% of these occur in developing countries. 126000 new cases and 71,000 deaths due to cervical cancer occur each year in India. More than 80% of cases are diagnosed at an advanced clinical stage. Cytology based screening programmes do not exists in India due to lack of funds, trained personnel and limited infrastructure.
S367
Objective: To evaluate if VIA could be used as an alternative to cytology as a screening method for diagnosis of pre-invasive lesion. Material and Method: 403 (69%) women were referred from gynaec OPD, 166 (29%) were self referred with no symptoms, and 11 (2%) healthy women were referred from family planning clinic. The Concurrent examination by cytology and VIA was carried out by an accredited Colposcopist and the gynae residents, on 580 women. All women were investigated with colposcopy and biopsies were taken from 211 women who had Colposcopic abnormality. The reference standard for final disease status was histologically confirmed CIN. Results: 76 (13%) women were diagnosed with histologically proved CIN. 54 (9%) were low grade CIN and 22 (4%) were diagnosed as high grade CIN. 9 women were diagnosed with invasive cervical cancer and were referred to oncology unit. The sensitivity of VIA to diagnose CIN was 92% and specificity was 69% while sensitivity of cytology to diagnose CIN was 61% and specificity was 82%. Conclusion: VIA is cost effective, reasonably accurate, and can be used as an alternative to cytology in screening programmes in a resource restricted settings. O964 Healing and functional outcomes after obstetric anal sphincter injury in HIV-positive vs HIV-negative patients J. Van den Berg, S. Jeffery Aim: To determine whether HIV-positive patients have a longer time to healing, more complications and poorer functional outcomes after Obstetric Anal Sphincter Injury (OASI) than an HIVnegative control group. Setting: Secondary and Tertiary hospitals of the Western Cape Peninsula Maternal and Neonatal Service. Methods: This was a prospective cohort study of all women with acute OASI delivering between September 2008 and July 2009. Initial assessment immediately following delivery included demographics, details of the perineal repair and pre-pregnancy anal, urinary and sexual function. This included a pre-pregnancy perineal pain score, a Wexner Score for anal incontinence, an assessment of urinary symptoms the Abbreviated Sexual Function Questionnaire (ASFQ). Women were followed up six weeks later, once again assessing them for anal, urinary and sexual function as well as perineal pain. All women were examined with particular attention to the integrity of the perineum and anal sphincter repair. Results: 68 women were enrolled including 54 HIV-negative and 14 HIV-positive women. There were no differences between the two groups with regards to severity of OASI. 36 women attended follow-up including 28 HIV-negative (78%) and 8 HIVpositive (22%). Using Wexner scores (where higher scores indicate a greater impact) at six weeks post OASI, HIV-positive women were significantly more likely to experience solid stool incontinence (mean Wexner Score 0.88 vs 0.11; p = 0.041), as well as a negative lifestyle impact (mean Wexner Score 0.88 vs 0.07; p = 0.007) compared to HIV-negative women with OASI. Of interest, postpartum de novo stress urinary incontinence at six weeks was more common in HIV-positive women (37.5% vs 0%; p = 0.0078). There were no significant differences in healing, infection, anal sphincter integrity or tone between the two groups at follow-up. Conclusion: HIV-positive patients experience significantly more solid stool incontinence and have poorer lifestyle impact scores after OASI at six weeks postpartum. HIV-positive women also appear to experience more de novo postpartum stress urinary incontinence than HIV-negative controls. Our study suggests that HIV-positive women may have poorer postpartum muscle function than HIV-negative women and this needs to be addressed by further studies.