Assisted Vaginal Birth

Murphy, Deirdre J; Strachan, Bryony; Bahl, Rachna; Gynaecologists,

doi:10.1111/1471-0528.16092

Cited by 101 publications

(31 citation statements)

References 143 publications

(211 reference statements)

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“…Obstetric variables included were epidural anesthesia, oxytocin augmentation, episiotomy (lateral incision to the left side), the duration of the second stage of labor defined as the time interval (in minutes) between complete cervical dilation and delivery of the child, neonatal birthweight (in grams), neonatal head circumference (in centimeters) and delivery mode.Vaginal delivery mode such as non-instrumental, vacuum or forceps delivery was registered. Vacuum and forceps delivery were attempted and performed in consensus with current obstetric guidelines 26. The investigators performing the ultrasonography were blinded to previous ultrasound assessments and obstetric history.…”

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confidence: 99%

Change in prevalence of major levator ani muscle defects from 6 weeks to 1 year postpartum, and maternal and obstetric risk factors: A longitudinal ultrasound study

Halle

Stær-Jensen

Hilde

et al. 2020

Acta Obstet Gynecol Scand

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Introduction The present study aimed first to investigate the change in prevalence of major levator ani muscle (LAM) defects, also called avulsions, from 6 weeks to 1 year postpartum, and second to assess maternal and obstetric risk factors for having persistent major LAM defects/avulsions at 1 year postpartum. Material and methods This is a secondary analysis of data from a prospective cohort study including 300 nulliparous women at 17‐19 weeks of gestation. Major LAM defects were diagnosed at 6 weeks and 1 year postpartum using transperineal ultrasonography. We defined persistent major LAM defects as a defect diagnosed both at 6 weeks and 1 year postpartum. Maternal and obstetric data were obtained from the hospital’s electronic birth records. Pelvic floor muscle function was measured vaginally by manometer at 21 weeks of gestation. The main outcome measurement was change in prevalence of major LAM defects. Maternal and obstetric risk factors for having persistent major LAM defect were also assessed. Results Prevalence of major LAM defects was 19.4% at 6 weeks and 10.4% at 1 year postpartum. No new major LAM defects were diagnosed at 1 year postpartum. Persisting major LAM defects were associated with longer second stage of labor (median 74.5 minutes vs median 48.0 minutes, P = .012) and higher neonatal birthweight (mean difference of 232.3 g, 95% confidence interval [CI] 21.5‐443.1). Vacuum delivery was independently associated with persistent major LAM defects, adjusted OR 3.0 (95% CI 1.0‐9.0). Conclusions There was a 50% reduction of sonographically diagnosed major LAM defects from 6 weeks to 1 year postpartum. This finding suggests that assessment of the major LAM 6 weeks postpartum may be too early to diagnose defects/avulsions. Long second stage of labor, high neonatal birthweight and vacuum delivery were associated with persistent major LAM defects/avulsions.

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confidence: 99%

Change in prevalence of major levator ani muscle defects from 6 weeks to 1 year postpartum, and maternal and obstetric risk factors: A longitudinal ultrasound study

Halle

Stær-Jensen

Hilde

et al. 2020

Acta Obstet Gynecol Scand

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“…11 Jeanne de Flandres maternity unit, Lille University Hospital, Lille, France. 12 Grenoble University Hospital, Department of Obstetrics and Gynecology, Grenoble, France.…”

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confidence: 99%

“…Because OASI is a low frequency event and because episiotomy has its own morbidity (pain, dyspareunia, infection), systematic episiotomy may induce more harm than good [9]. There are consequently no clear recommendations about its use during operative vaginal delivery [2,12,13].…”

Section: Introductionmentioning

confidence: 99%

A core outcome set development for a French national prospective study about the effect of mediolateral episiotomy on obstetric anal sphincter injury during operative vaginal delivery (INSTRUMODA)

Gachon

Schmitz

Parant

et al. 2021

BMC Pregnancy Childbirth

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Background We aimed at developing a core outcome and variables of interest set to investigate the effects of mediolateral episiotomy on Obstetric Anal Sphincter Injury (OASI) during and after operative delivery in nulliparous women in a large-scale one-year observational French study including 15,000 women (INSTRUMODA). Methods A list of outcomes and variables of interest was suggested to obstetricians participating in the INSTRUMODA study using online questionnaires divided into 7 categories: the woman’s history and course of pregnancy, course of labor, modalities of operative delivery, episiotomy characteristics, immediate maternal morbidity, one-year maternal morbidity, immediate neonatal morbidity. We used a three-round DELPHI method to reach a consensus. In the first round, outcomes and variables considered as essential by 70% or more of obstetricians were included in the corpus whereas they were excluded when 70% rated them as “not important”. In the second round, non-consensual outcomes and variables were reassessed and excluded or definitively included if considered as “not important” or essential by 50% or more of the obstetricians. During the first round, obstetricians were invited to suggest new outcomes and/or variables that were then assessed in the second and third round. We used the same method to develop a core outcome and variables of interest set in a population of women in the community recruited via an association of patients. At the end of the procedure the core outcome and variables of interest sets were merged to provide the final core outcome set for the INSTRUMODA study. Results Fifty-three obstetricians and 16 women filled out questionnaires. After the 3 rounds of Delphi procedure in each population, 74 outcomes and variables were consensually reported by obstetricians and 92 by women in the community. By mixing these two consensual corpora we reported a final consensual list of 114 variables of interest and outcomes for both obstetricians and women. Conclusion We established a core outcome and variables of interest set among obstetricians and women in the community to investigate the association between mediolateral episiotomy and OASI during operative delivery. Trial registration The INSTRUMODA study was registered on https://clinicaltrials.gov on June 25, 2020 (NCT04446780).

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“…Birth Trauma organizations advocate on behalf of women and babies who have experienced adverse outcomes, and naturally, they will take a risk‐averse perspective on birth‐related care. The latest version of the Assisted Vaginal Birth (AVB) RCOG Guideline (previously called Operative Vaginal Delivery) has focused specifically on revisions designed to minimize the risk of traumatic injuries for the mother and baby 1 . The landmark Montgomery ruling that raised the bar on the standard required for informed consent has been embraced and endorsed within the guideline 2 .…”

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confidence: 99%