Episiotomy in vacuum-assisted delivery affects the risk of obstetric anal sphincter injury: a systematic review and meta-analysis

Lund, Ninna Sønderby; Persson, Lisa K. G.; Jangö, Hanna; Gommesen, Ditte; Westergaard, Hanne Brix

doi:10.1016/j.ejogrb.2016.10.013

Cited by 90 publications

(111 citation statements)

References 33 publications

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“…The use of episiotomy appeared to be less common in singleton deliveries, in keeping with the lower rates of instrumental deliveries seen in this group. This is in agreement with the evidence that episiotomy decreases the risk of OASIS during instrumental delivery . Episiotomy is more protective when performed with instrumental versus spontaneous delivery …”

Section: Discussionsupporting

confidence: 91%

A comparative study of obstetric anal sphincter injuries in vaginal deliveries of twins and singleton pregnancies

Doumouchtsis

Fahmay

Sedgwick

et al. 2018

Neurourology and Urodynamics

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Section: Discussionsupporting

confidence: 91%

A comparative study of obstetric anal sphincter injuries in vaginal deliveries of twins and singleton pregnancies

Doumouchtsis

Fahmay

Sedgwick

et al. 2018

Neurourology and Urodynamics

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“…In the present study, we found that the episiotomy rate increased significantly after implementation of the formal prevention programs and to a lesser extent also at the hospitals without formal prevention programs. Especially, the rate of episiotomy increased in vacuum‐assisted deliveries, possibly as a result of recent data that this protects against OASIS in primiparous women . In Norway, education in episiotomy technique was one of the central parts in the prevention of OASIS.…”

Section: Discussionmentioning

confidence: 99%

Changing incidence of obstetric anal sphincter injuries—A result of formal prevention programs?

Jangö

Westergaard

Kjærbye‐Thygesen

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Obstetric anal sphincter injuries (OASIS) are serious complications to vaginal delivery causing anal incontinence in 50% of the women in the long term. In Norway, the incidence of OASIS has been significantly reduced from 4%‐5% to 1%‐2% after implementation of prevention programs focusing on perineal protection. The aim of our study was to evaluate whether implementation of formal prevention programs was associated with a reduced incidence of OASIS over time. Material and methods We performed a historical cohort study, evaluating incidence, change of incidence and risk factors of OASIS during the years 2011‐2015 at the four delivery departments in the Capital Region of Denmark. Two of the four departments implemented formal prevention programs in 2012‐2013. We performed trend tests and uni‐ and multivariable analyses, adjusting for important risk factors and calculating interactions between risk factors. Results There were 75 173 vaginal deliveries during the study period; of those, 2670 (3.6%) were complicated by OASIS. The incidence of OASIS decreased during the study period from 4.3% (n = 636) in 2011 to 2.6% (n = 399) in 2015. There was a significant decrease in the incidence of OASIS at both the departments with formal prevention programs and those without. After adjustment for other important risk factors of OASIS, we found no significant difference in the risk reduction between departments with and without formal prevention programs. Conclusions We found that the general focus on prevention of OASIS in Denmark was associated with a significant decrease in the incidence of OASIS, but implementation of formal prevention programs did not lead to a further reduction. It is possible that more rigorous interventions at the hospitals with formal prevention programs could have resulted in a significant difference in incidence of OASIS.

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“…When episiotomy is performed, mediolateral episiotomy is associated with a lower risk of anal sphincter injury compared with median episiotomy [11]. In a sys- tematic review and meta-analysis of 15 studies comparing mediolateral or lateral episiotomy with no episiotomy in primiparous women undergoing vacuum-assisted delivery, mediolateral or lateral episiotomy was associated with an approximately 50% reduction in risk of anal sphincter laceration compared with no episiotomy (OR 0.53, 95% CI 0.37-0.77) [29]. Based on this study, 19 women would have to undergo mediolateral or lateral episiotomy during vacuum extraction to prevent one anal sphincter laceration.…”

Section: Existing Guidelines and Current Recommendations For The Use mentioning

confidence: 99%

Management of the Perineum during Delivery with the Kiwi Omnicup: Effects of Mediolateral Episiotomy on Anal Sphincter Tears in Nulliparous Women

Kimberger¹,

Käfer²,

Husslein³

et al. 2017

Gynecol Obstet Invest

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Aim: The main objective of this study was to evaluate the association of mediolateral episiotomy with severe perineal trauma during Kiwi omnicup vacuum delivery. Methods: This retrospective study analyzed all Kiwi omnicup vacuum deliveries between 2010 and 2015 in nulliparous women. Secondary outcomes of interest included frequency of genital tract trauma, outcome of Kiwi extraction and influence on neonatal parameters. Results: A total of 572 nulliparous women who were delivered with the aid of vacuum were analyzed. Successful completion of birth was achieved in 549/572 (96%) resulting in a failure rate of 4%. Out of 572 women, 372 (65%) underwent the Kiwi vacuum delivery system in conjunction with episiotomy. Third- or fourth-degree perineal tears occurred in 38 out of the 572 (6.6%) women and the rate of severe perineal trauma was statistically and significantly lower in women who delivered with the aid of the Kiwi vacuum in conjunction with episiotomy (p = 0.0001). Besides, perineal tears of all degrees, vaginal tears and labial trauma were significantly less common in the Kiwi vacuum delivery system when combined with mediolateral episiotomy (p = 0.0001, p = 0.006, and p = 0.0001, respectively). Conclusion: Our data showed that the performance of a mediolateral episiotomy was associated with a decreased risk of severe perineal tears as well as vaginal and labial trauma in Kiwi omnicup vacuum deliveries.

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Episiotomy in vacuum-assisted delivery affects the risk of obstetric anal sphincter injury: a systematic review and meta-analysis

Cited by 90 publications

References 33 publications

A comparative study of obstetric anal sphincter injuries in vaginal deliveries of twins and singleton pregnancies

A comparative study of obstetric anal sphincter injuries in vaginal deliveries of twins and singleton pregnancies

Changing incidence of obstetric anal sphincter injuries—A result of formal prevention programs?

Management of the Perineum during Delivery with the Kiwi Omnicup: Effects of Mediolateral Episiotomy on Anal Sphincter Tears in Nulliparous Women

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