Is there still an indication for episiotomy? Results from a French national database analysis

Abstract

Objective To assess the link between mediolateral episiotomy and the occurrence of obstetrical anal sphincter injury (OASIS). Methods Data were collected from the national database (PMSI; Programme de Médicalisation des Systèmes d'Information). Women between 18 and 50 years old, undergoing a vaginal delivery in France in 2018 were included. The main outcome was factors associated with a higher adjusted OASIS rate after a vaginal delivery. Results Of 623 003 women with a vaginal delivery, 239 949 were primiparous (38.5%), 62 310 experienced mediolateral episiotomy (10.0%) and 7077 had a third‐ or fourth‐degree perineal tear (1.14%). Risk factors for OASIS were primiparity (adjusted odds ratio [OR] 2.97), shoulder dystocia (aOR 2.57), instrumental delivery (aOR 2.81), gestational diabetes (aOR 1.20), and post‐term delivery (aOR 1.53). Mediolateral episiotomy increased the occurrence of OASIS for women without an instrumental delivery, either for parous (OR 1.32, 95% confidence interval [CI] 1.07–1.62) or primiparous (OR 1.26, 95% CI 1.13–1.39) women. In contrast, episiotomy among primiparous women with episiotomy and a vacuum or forceps delivery significantly decreased the risk for OASIS (OR 0.62, 95% CI 0.56–0.67). Conclusions The practice of routine episiotomy should be discouraged. Selective mediolateral episiotomy should be considered with extreme caution and mainly for primiparous women during instrumental vaginal delivery. Further randomized trial may confirm such results.

Letter to the editor: Is there still an indication for episiotomy? Results from a French national database analysis

“…Results from a French national database analysis First, we would like to thank Mathieu Levaillant and colleagues for their work on the impact of the mediolateral episiotomy on the risk of OASIS (occurrence of Obstetrical Anal Sphincter Injury). 1 We agree with the first part of their conclusion: "the practice of routine episiotomy should be discouraged". However, we disagree with the second part: "selective episiotomy should be considered […] mainly for primiparous women during instrumental vaginal delivery".…”

“…First, we would like to thank Mathieu Levaillant and colleagues for their work on the impact of the mediolateral episiotomy on the risk of OASIS (occurrence of Obstetrical Anal Sphincter Injury) 1 . We agree with the first part of their conclusion: “the practice of routine episiotomy should be discouraged”.…”