Issue link: http://digitaleditions.uberflip.com/i/1388210
NMH Annual Rep t | 2020 103 Maternity and Obstetrics T he Perineal Clinic has been running in the National Maternity Hospital for almost 30 years. It was one of the first clinics of its kind in Europe and, within Ireland, is only one of two clinics that are currently functioning. The primary remit of the service is to ensure that women who have sustained an anal sphincter injury following childbirth are recovering well and are not suffering from faecal incontinence. If they are, the clinic ensures timely referral to physiotherapy and surgical services, if warranted. In addition, we counsel antenatal patients, who have previously sustained such an injury, on future mode of delivery. Once a month the clinic is held in St Michael's Hospital, Dun Laoghaire along with Dr Gerry Agnew, Consultant Obstetrician and Gynaecologist, and Ms Ann Hanly, Consultant in Colorectal Surgery. This multidisciplinary clinic caters for the more complex, mixed pictures of incontinence and has taken a proportion of referrals away from the NMH clinic. 2020 was hugely impacted on all levels by the arrival of COVID-19. The Perineal Clinic, like all clinics, was affected by cancellations, conversion to telemedicine clinics and a gradual resumption of services, albeit on a smaller scale to ensure social distancing. However, we continued to see a core group of women throughout the course of the pandemic. These women were experiencing significant postpartum difficulties. By Perineal Clinic September, the clinic was functioning as normal with slightly reduced numbers to comply with social distancing measures. As in previous years, our referrals are primarily for postpartum assessment of obstetric anal sphincter injury. We are the tertiary referral centre for such tears for many units throughout the country and almost half of our referrals are from other units. We assess patients at 4 to 6 months postnatal and for that reason, the number of NMH patients that attend the clinic in a calendar year will not match the actual number of Obstetric Anal Sphincter Injuries (OASIS) that occur in NMH in that same year. In addition, a percentage of patients will not attend the Perineal Clinic for follow up. We are extremely keen to assess as many women as possible following OASIS but in particular, knowing how our own NMH patient cohort is faring is vital and is a direct reflection on the standard of care we are providing within the hospital. For that reason, a smooth referral pathway from the postnatal wards to the Postnatal (Poppy) clinic to the Perineal clinic is essential. The importance of attending for the visit is emphasised at all points but despite this, we have a stubbornly high DNA rate of 22%. The persistent DNA rate is disappointing but is mirrored in other clinics. A total of 86 women were recorded as having sustained OASIS in the NMH in 2020 giving an NMH Annual Rep t | 2020