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Women were reviewed 3 months postpartum following OASI and in the second half of a subsequent pregnancy. Anorectal symptoms were measured using the validated St Mark\u2019s Incontinence Score (SMIS: asymptomatic to mild symptoms\u2009=\u2009\u2264 4). Anal manometry (incremental maximum squeeze pressure [iMSP: normal = &gt; 20\u00a0mmHg]) and EAUS (abnormal\u2009=\u2009sphincter defect &gt; 1\u00a0h in size) were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred forty-six women were identified and 67.8% had an anal sphincter defect \u2264 1\u00a0h in size postnatally. In those with a defect \u2264 1\u00a0h, postpartum mean iMSP and SMIS significantly improved in a subsequent pregnancy (<jats:italic>p<\/jats:italic>\u2009=\u20090.04 and<jats:italic>p<\/jats:italic>\u2009=\u20090.01, respectively). In women with a defect &gt; 1\u00a0h, there was no significant difference between the mean iMSP or SMIS score postnatally compared to a subsequent pregnancy. At both time points, significantly more women had an anal sphincter defect \u2264 1\u00a0h and SMIS of \u2264 4 (<jats:italic>p<\/jats:italic>\u2009=\u20090.001 and\u00a0<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001\u00a0respectively) compared to those with a defect &lt; 1\u00a0h. In addition, significantly more women had an anal sphincter defect \u2264 1\u00a0h and iMSP \u2265 20\u00a0mmHg (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Overall, out of the 146 women included in this study, 76 (52.1%) with a defect \u2264 1\u00a0h also had an iMSP \u2265 20\u00a0mmHg and SMIS \u2264 4 at 3 months postpartum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Women who remain asymptomatic with normal anal manometry and no abnormal sphincter defects on EAUS postnatally do not need to have these investigations repeated in a subsequent pregnancy and can be recommended to have a vaginal delivery. If our protocol was modified, over half of the women in this study could have had their MOD recommendation made in the postnatal period alone.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00192-020-04607-8","type":"journal-article","created":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T11:03:34Z","timestamp":1606907014000},"page":"1719-1726","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Effect of a subsequent pregnancy on anal sphincter integrity and function after obstetric anal sphincter injury (OASI)"],"prefix":"10.1007","volume":"32","author":[{"given":"Nicola Adanna","family":"Okeahialam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranee","family":"Thakar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8979-2304","authenticated-orcid":false,"given":"Abdul H.","family":"Sultan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,12,2]]},"reference":[{"key":"4607_CR1","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.ejogrb.2020.06.048","volume":"252","author":"M Sideris","year":"2020","unstructured":"Sideris M, McCaughey T, Hanrahan JG, et al. 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