Operative vaginal delivery and midline episiotomy: A bad combination for the perineum

Kudish, Bela; Blackwell, Sean C.; McNeeley, S. Gene; Bujold, Emmanuel; Krüger, Michael; Hendrix, Susan L.; Sokol, Robert J.

doi:10.1016/j.ajog.2006.06.078

Cited by 107 publications

(72 citation statements)

References 15 publications

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“…Other studies report a negative effect of a combined use of operative vaginal delivery and episiotomy, but solely with midline episiotomy 31, 32, 33. Kudish et al32 found a 20‐fold risk of anal sphincter injuries if a joint use of forceps and midline episiotomy was performed, and a 14‐fold increase in vacuum‐assisted delivery with midline episiotomy.…”

Section: Discussionmentioning

confidence: 99%

Risk and protective factors for obstetric anal sphincter injuries: A retrospective nationwide study

Marschalek

Worda

Kuessel

et al. 2018

Birth

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BackgroundIn view of the reported increase in obstetric anal sphincter injuries, the objective of this study was to evaluate the incidence of such injuries over time and the associated risk and protective factors.MethodsThis was a retrospective cohort study from a national database of 168 137 primiparous women with term, singleton, cephalic, vaginal delivery between 2008 and 2014. The main outcome measure was obstetric anal sphincter injury. A multivariate regression model was used to identify risk and protective factors.ResultsAge >19 years, birthweight >4000 g, and operative vaginal delivery were independent risk factors for obstetric anal sphincter injuries. Mediolateral episiotomy increased the risk for obstetric anal sphincter injuries in spontaneous vaginal birth (number needed to harm 333), whereas it was protective in vacuum delivery (number needed to treat 50). From 2008 to 2014, there was an increase in the rate of obstetric anal sphincter injuries (2.1% vs 3.1%, P < .01), vacuum deliveries (12.1% vs 12.8%, P < .01), and cesarean delivery after labor (17.1% vs 19.4%, P < .01), while forceps deliveries (0.4% vs 0.1%, P < .01) and episiotomy rate decreased (35.9% vs 26.4%, P < .01).ConclusionsEpisiotomy may be a risk or protective factor depending on the type of episiotomy and the clinical setting in which it is used. Our study supports a restrictive use of mediolateral episiotomy in spontaneous vaginal deliveries. In vacuum deliveries mediolateral episiotomy may help prevent obstetric anal sphincter injuries.

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Section: Discussionmentioning

confidence: 99%

Risk and protective factors for obstetric anal sphincter injuries: A retrospective nationwide study

Marschalek

Worda

Kuessel

et al. 2018

Birth

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“…Finally, of 812 initial reports, 15 articles encompassing 350 764 vacuum deliveries were included in the meta-analysis. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Table 1 summarises the characteristics of the studies. Fourteen articles described studies that were observational cohorts in nature, with only one study involving prospective data acquisition, 20 and one additional article describing case-control analysis.…”

Section: Resultsmentioning

confidence: 99%

“…17 A review protocol can be assessed at the PROSPERO international prospective register of systematic reviews (www.crd.york.ac.uk/PROS-PERO, reg. no.…”

Section: Methodsmentioning

confidence: 99%

Morbidity associated with episiotomy in vacuum delivery: a systematic review and meta‐analysis

Sagi‐Dain

Sagi

2015

BJOG

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Background The role of episiotomy in vacuum deliveries is controversial.Objectives To perform a meta-analysis of the literature examining this subject.Search strategy The search was conducted in four databases.Selection criteria Two investigators independently selected original research examining the effects of episiotomy on any neonatal and maternal outcomes during vacuum delivery.Data collection and analysis The effect estimates were presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).Main results Fifteen articles were included, encompassing a total of 350 764 vacuum deliveries. A non-significant relationship was shown between mediolateral episiotomy and obstetric anal sphincter injuries (OASIS) in nulliparous women (OR 0.68, 95% CI 0.43-1.07; six studies), whereas an increased risk was demonstrated in parous women (OR 1.27, 95% CI 1.05-1.53; two reports). A higher risk of OASIS with median episiotomy use was shown in nulliparous (OR 5.11,; two studies) as well as in parous (OR 89.4, 95% CI 11.8-677.1; one study) women. Lateral episiotomy was related to lower OASIS risk in nullipara (OR 0.59, 95% CI 0.49-0.70; single paper). Mediolateral episiotomy was linked to increased rates of postpartum haemorrhage (OR 1.82, 95% CI 1.16-2.86) and analgesia use (OR 2.10, 95% CI 1.39-3.17; two reports). Overall, the quality of evidence was rated as low to very low.Author's conclusions Mediolateral and median episiotomy in parous woman may increase the rate of OASIS at vacuum delivery, whereas lateral episiotomy in nulliparous women could be associated with a decreased risk of OASIS. The suboptimal quality of the available evidence necessitates high-quality welldesigned randomised trials.Keywords Episiotomy, obstetric anal sphincter injury, vacuum extraction delivery.Tweetable abstract Episiotomy in vacuum delivery does not appear to be of benefit, and might even increase maternal morbidity.

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“…Bu dokular cerrahi olarak kesilirse do¤um eylemi sekteye u¤rar. Bu veriler sonucunda, vakumla do¤um esnas›nda rutin epizyotomi önerilmemektedir (27) .…”

Section: Operatif Do¤um Ve Epizyotomiunclassified

Vaginal Delivery With Vacuum Extraction

Sanhal¹,

Kazandı²,

Mete³

2011

J Turk Soc Obstet Gynecol

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ÖZET SUMMARY VAGINAL DELIVERY WITH VACUUM EXTRACTIONOperative vaginal delivery is simply defined as the use of either vacuum or forceps device to asist mother in effecting vaginal delivery of a fetus. Medicolegal problems, patients desire and the obstetricians position after a possible complication of the vaginal delivery has increased the rate of ceserean section. With the recent enforcements among obstetricians to reduce this rate, operative vaginal delivery will come forward in delivery and labor practice.In this review, we discussed the indications, contrindications, patient selection, maternal -neonatal risks and the technique of vacuum extraction for a safe expedient vaginal delivery.

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Operative vaginal delivery and midline episiotomy: A bad combination for the perineum

Cited by 107 publications

References 15 publications

Risk and protective factors for obstetric anal sphincter injuries: A retrospective nationwide study

Risk and protective factors for obstetric anal sphincter injuries: A retrospective nationwide study

Morbidity associated with episiotomy in vacuum delivery: a systematic review and meta‐analysis

Vaginal Delivery With Vacuum Extraction

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