Obstetric anal sphincter injuries in vaginal delivery of twins: associated risk factors and comparison with singletons

Porat, Shay; Baud, David; Farine, Dan

doi:10.1007/s00192-012-1923-8

Cited by 7 publications

(6 citation statements)

References 26 publications

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“…Another Canadian report 14 found the rate of OASI to be 2.8% in twin deliveries versus 4.4% in singletons, which is higher than our figures. They identified instrumental delivery as a risk factor for OASI 13,14 comparable to our own findings. Both studies are retrospective reports, one from a large maternity unit 13 and the second from a birth population database.…”

Section: Discussionsupporting

confidence: 89%

“…It is noteworthy that 50% of sphincter injuries in our study included damage to the rectal mucosa (fourthdegree tears), considerably higher than the 90%:10% ratio reported in the literature. 13 Similarly, our institutional rates of third-and fourth-degree tears over the study period are 95.7 and 4.3%, respectively. While our analysis is limited by our smaller sample size, it does raise the possibility that while OASI is rarer in twin deliveries, the severity of these injuries may be worse.…”

Section: Discussionsupporting

confidence: 50%

“…The epidemiology of OASI in singleton pregnancies has been reported extensively [9][10][11][12] ; however, there are limited data on both the incidence and risk factors in multiple gestations. 13,14 The rate of multiple births has been shown to have increased in recent decades, 15 largely due to assisted reproduction techniques. 16 Vaginal delivery of twins can be a clinical challenge, 17 potentially involving the use of both instrumentation (either vacuum or forceps) and obstetric maneuvers (internal podalic version or breech extraction).…”

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confidence: 99%

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Anal Sphincter Injury Associated with Vaginal Twin Delivery

et al. 2019

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Objective Obstetric anal sphincter injury remains the most common cause of fecal incontinence in women, and research in twin pregnancies is sparse. This study aimed to examine risk factors for sphincter injury in twin deliveries over a 10-year period. Study Design This was a retrospective study of twin vaginal deliveries in a tertiary-level hospital over 10 years. We examined the demographics of women who had a vaginal delivery of at least one twin. Logistic regression analysis was used to examine risk factors. Result There were 1,783 (2.1%) twin pregnancies, of which 556 (31%) had a vaginal delivery of at least one twin. Sphincter injury occurred in 1.1% (6/556) women with twins compared with 2.9% (1720/59,944) singleton vaginal deliveries. Women with sphincter injury had more instrumental deliveries (83.3 vs. 27.6%; p = 0.008). On univariate analysis, only instrumental delivery was a significant risk factor (odds ratio: 2.93; p = 0.019). Conclusion Sphincter injury occurs at a lower rate in vaginal twin pregnancies than in singletons. No twin-specific risk factors were identified. Discussion of the risk of sphincter injury should form part of patient counseling with regard to the mode of delivery.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 50%

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confidence: 99%

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Anal Sphincter Injury Associated with Vaginal Twin Delivery

et al. 2019

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“…No data are available in the literature to compare such results, because twin or higher multiple pregnancies are often excluded from OASIS risk‐factor analysis. Two studies that investigated twin versus singleton births only found that risk factors were the same across both kinds of deliveries 27,28 …”

Section: Discussionmentioning

confidence: 99%

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

Levaillant

Loury

Venara

et al. 2022

Intl J Gynecology & Obste

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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.

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“…There is limited research to date comparing women delivering twins with those delivering singletons in the risk of OASIS, mainly due to delivery at earlier gestations. Common risk factors in the two groups include nulliparity, fetal position, size, and instrumental delivery . However, it is still not clear whether twin deliveries, which are known to have longer second stage of labor and higher rates of obstetric interventions, expose women to higher risk of OASIS in comparison with singleton pregnancies provided the gestation age is similar.…”

Section: Introductionmentioning

confidence: 99%

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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Obstetric anal sphincter injuries in vaginal delivery of twins: associated risk factors and comparison with singletons

Abstract: Risk factors of nulliparity, OP position, large fetal size, and instrumental delivery were shared by both twin and singleton deliveries. These data will be useful in counselling women carrying twins who intend to deliver vaginally.

Cited by 7 publications

References 26 publications

Anal Sphincter Injury Associated with Vaginal Twin Delivery

Anal Sphincter Injury Associated with Vaginal Twin Delivery

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

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

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