The incidence of perineal trauma causing injury to anal sphincter muscles during childbirth is expected to be between 0.5-1.5%. The calculated rate of occurrence is largely influenced by a wide range of variants and differs between countries. The obstetric anal sphincter injuries detection and management have entered a new age since the introduction of ultrasound in assessing suspected injuries. Advancements in Imaging have helped identifying both internal and external anal sphincter defects following mechanical trauma as a result of vaginal birth. However, the incidence of what is known as occult anal sphincter injury is suggested to be around 35% in primiparous women and 44% in multiparous women (1). That indicates that we are still behind in our methods of detection. In turn, it means that we are allowing for patients to develop long-term effects for their injuries and with late detection comes poorer outcomes. This is especially true in the incidence of women complaining of anal incontinence following obstetric trauma, which can be as high as 30-50% (2).

 There is a ripple effect for obstetric trauma that may last the total length of individual’s life. It also has multiple parallel repercussions involving sexual functions, marital relationships and even future pregnancies. Recent studies suggested that the actual life-long effects of such traumas are under examined (3). Management of obstetric trauma starts at a much earlier stage, outside the delivery suite. Like many other cases in medicine, there are no ideal solution or a “Silver Bullet” to prevent, treat and manage obstetric trauma. Managing affected patients often involves multidisciplinary teams, generous resources and dedicated services. It often starts with training doctors and midwives in the art of prevention for such traumas while being fully equipped to detect and treat them properly. However, there are a limited number of reversible factors that can be used to mitigate the risks in sustaining these injuries and the rest are not preventable. Appropriate short and long-term management is the key to providing healthier outcomes for these patients. As much as it is vital for patients affected by such physical and in many cases psychological trauma to be managed appropriately, it is just as important for them to be followed up post-delivery.

 Current literature suggests that long-term outcomes following primary repair of OASI are not encouraging (3). A significant number of affected women decide against further pregnancy and most symptomatic women who have further pregnancies opt to deliver by caesarean section. This in turn places significant pressure on public health services and on the hospitals. Management of the physical side of the trauma may be a short-term task that is attainable, however the physcological aspect should not be ignored.

The management of patients with perineal trauma requires the skills for detection, the training for repair, and the care for follow up. This review takes a snap shot of the services available for these patients and methods to address any pitfalls along the path of delivery for these services.