Impact of Episiotomy During Operative Vaginal Delivery on Obstetrical Anal Sphincter Injuries

Frenette, Priscilla; Crawford, Susan; Schulz, Jane; Ospina, Maria

doi:10.1016/j.jogc.2019.02.016

Cited by 16 publications

(9 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, even if it was not the objective of our study, we have confirmed some important information about risk factors of OASIS occurrence: history of OASIS, fetal head position (transverse or posterior), and shoulder dystocia, 1,18 thus reinforcing the external validity of our study. Interestingly, we also confirmed a potential protective role of episiotomy regarding the risk of OASIS during VE 19 …”

Section: Discussionsupporting

confidence: 79%

Is sonographic measurement of head‐perineum distance useful to predict obstetrical anal sphincter injury in case of vacuum delivery?

Garabédian

Plurien

Benoit

et al. 2022

Intl J Gynecology & Obste

View full text Add to dashboard Cite

Objective Determine if head‐perineum distance (HPD) measurement before vacuum extraction (VE) was predictive of an obstetric anal sphincter injury (OASIS) occurrence. Methods Retrospective, bicentric (Lille and Poissy, France) cohort study conducted from January 2019 to June 2020. All VE in singleton pregnancies of ≥34 weeks were included. HPD measurement was performed without compression of the tissues before each VE. The judgment criterion was the occurrence of an OASIS. Results Of 12 568 deliveries, VE was performed in 1093 (8.6%). Among these 1093 women undergoing VE, 675 (61.7%) with HPD measurement were included. OASIS was found in 6.5% of women (n = 44; 95% CI 4.5–8.7). HPD was not associated with OASIS (38.5 ± 12.6 mm in women with OASIS vs 37.4 ± 12.0 mm in women without; adjusted OR [aOR] per 5 mm increase = 0.92; 95% CI 0.79–1.06). Increased HPD was associated with higher risk of sequential extraction (aOR = 1.19; 95% CI 1.06–1.32), extraction duration >10 min (aOR = 1.12; 95% CI 1.02–1.23) and shoulder dystocia (aOR = 1.20; 95% CI 1.03–1.40). Conclusion Ultrasound‐measured head‐perineum distance does not predict the occurrence of obstetric anal sphincter injury during a VE. The interest of HPD is more about predicting the success or difficulty of VE rather its specific complications.

show abstract

Section: Discussionsupporting

confidence: 79%

Is sonographic measurement of head‐perineum distance useful to predict obstetrical anal sphincter injury in case of vacuum delivery?

Garabédian

Plurien

Benoit

et al. 2022

Intl J Gynecology & Obste

View full text Add to dashboard Cite

show abstract

“…Interestingly, while assisted vaginal delivery is a more accepted indication for episiotomy-to facilitate placement of a vacuum or forceps-we found it was less likely to be used in these births [AIRR 0.76 (95% CI 0.60-0.96)] though the p-value did not meet the prespeci ed cut-off of p < 0.05 when adjusted using the BH procedure. (14,(34)(35)(36) We also found an association between episiotomy and obstructed/prolonged labor even when adjusting for use of assisted vaginal delivery and maternal characteristics (AIRR 1.29, 95% CI 0.57-1.59), which could indicate its use as an intervention for obstructed/prolonged labor. While episiotomy has been shown to improve outcomes for obstructed/prolonged labor in women with female genital mutilation, this cultural practice is not common in the population we studied.…”

Section: Discussionmentioning

confidence: 74%

“…Prior research has identi ed a number of maternal risks of episiotomy, such as obstetric anal sphincter injury. (10,13,14) We found that women who underwent episiotomy were over four times more likely to be exposed to antibiotics (AIRR 4.31, 95% CI 3.17-5.87) with an overall incidence of 96.9% in this group. Potential risks of antibiotic exposure include Clostridium di cile infection, development of multi-drug resistant organisms, and serious allergic reaction.…”

Section: Discussionmentioning

confidence: 82%

“…There are well documented risks associated with its use, including excessive blood loss, wound dehiscence, infection, and increased risk of severe lacerations in future deliveries. (10)(11)(12)(13)(14) A Cochrane systematic review on the topic concluded that restrictive use of episiotomy leads to better clinical outcomes-including a decreased incidence of severe (third-and fourthdegree) lacerations-as compared to routine use. (6) In 2018, the World Health Organization (WHO) recommended against its routine/liberal use.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Trends and Determinants of the Use of Episiotomy in a Prospective Population-Based Registry from Central India

Austad

Rao

Hibberd

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Findings from research and recommendations from the World Health Organization favors restrictive use of episiotomy, but whether this guidance is being followed in India and factors associated with its use are not known. Methods: We conducted a secondary analysis of data collected by the Maternal Newborn Health Registry, a prospective population-based pregnancy registry established in Central India (Nagpur, Eastern Maharashtra). We examined mode of delivery and use of episiotomy in vaginal deliveries from 2014 to 2018, as well as maternal and birth characteristics, health systems factors, and concurrent obstetric interventions associations with its use with multivariable Poisson regression models. Results: During the five-year interval, the rate of episiotomy in vaginal birth rose from 13% to 31% despite a decline in assisted vaginal delivery. In the adjusted analysis prior birth, multiple gestations, seven or more years of maternal education, higher gestational age, higher birthweight, delivery by an obstetrician (as compared to midwife or general physician), and birth in hospital (as compared to clinic or health center) were associated with episiotomy. After adjusting for these factors, year over year rise in episiotomy was significant with an adjusted incidence rate ratio (AIRR) of 1.10 [95% confidence interval (CI) 1.08-1.13; p=0.018]. We found an association between episiotomy and several other obstetrics interventions, with the strongest relationship for maternal treatment with antibiotics (AIRR 4.31, 95% CI 3.17 – 5.87; p=0.003). Conclusions: Episiotomy in this population-based sample from central India steadily rose from 2014 to 2018. This increase over time was observed even after adjusting for patient characteristics, obstetric risk factors, and health system features, such as specialty of the delivery provider. Our findings have important implications for maternal-child health and respectful maternity care given that most women prefer to avoid episiotomy; they also highlight a potential target for antibiotic stewardship as part of global efforts to combat antimicrobial resistance. Trial Registration: The trial was registered at ClinicalTrials.gov under reference number NCT01073475.

show abstract

“…34 Variation in policy regarding the use of episiotomy in OVD may also be a factor. Accumulating evidence supports the routine use of mediolateral episiotomy in OVD, particularly among people having their first vaginal delivery, [35][36][37][38] yet recommendations surrounding episiotomy in OVD are inconsistent across countries. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommends use of routine episiotomy for all people having their first vaginal birth and requiring OVD, 14 but restrictive use of mediolateral episiotomy in OVD is recommended in Canada.…”

Section: Discussionmentioning

confidence: 99%

Maternal and neonatal trauma following operative vaginal delivery

Muraca

Boutin

Razaz

et al. 2022

CMAJ

View full text Add to dashboard Cite

Background: Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume. Methods:We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression.Results: Of 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%-25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6-10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%-13.4%) and 9.6 (95% CI 9.0-10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65-1.75) and varied by region, but not by level of obstetric care.Interpretation: In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada.

show abstract

Impact of Episiotomy During Operative Vaginal Delivery on Obstetrical Anal Sphincter Injuries

Cited by 16 publications

References 26 publications

Is sonographic measurement of head‐perineum distance useful to predict obstetrical anal sphincter injury in case of vacuum delivery?

Is sonographic measurement of head‐perineum distance useful to predict obstetrical anal sphincter injury in case of vacuum delivery?

Trends and Determinants of the Use of Episiotomy in a Prospective Population-Based Registry from Central India

Maternal and neonatal trauma following operative vaginal delivery

Contact Info

Product

Resources

About