Detection of obstetric anal sphincter injuries: From the fear of malpractice to a quality indicator of a center.

Obstetric anal sphincter injuries (OASIs) constitute a significant complication in vaginal childbirth, affecting up to 26% of deliveries and representing the leading cause of anal incontinence among women. Despite their prevalence and serious long-term consequences, OASIs remain widely underreported, partly because of clinicians' hesitancy linked to fear of litigation, peer criticism, and a pervasive culture that discourages disclosure of adverse events. Recent evidence emphasizes that underreporting exacerbates rather than mitigates legal risks and patient harm, underscoring the urgent need for systemic changes. This article reviews critical factors contributing to OASI underreporting, including inadequate clinical training, inconsistent national guidelines, variable litigation landscapes, and differing diagnostic practices across European healthcare systems. Examples from the UK, Poland, Sweden, Norway, France, Italy, the Czech Republic, and Belgium demonstrate significant variations in prevention strategies, diagnostic accuracy, and management protocols, reflecting uneven progress and highlighting opportunities for standardized care improvements. These national discrepancies in OASI definitions, classification, and reporting thresholds may lead to significant inconsistencies in both clinical outcomes and statistical comparisons across healthcare systems. Implementing structured training, standardized protocols, multidisciplinary collaboration, and transparent reporting systems are essential for improving maternal outcomes and reducing litigation risks. Encouraging an institutional culture of accountability and openness will support continuous improvement, ensuring enhanced patient safety and quality care across global healthcare systems.