Classification of episiotomy: towards a standardisation of terminology

Kališ, Vladimír; Laine, Katariina; Leeuw, JW de; Ismail, KM; Tincello, DG

doi:10.1111/j.1471-0528.2011.03268.x

Cited by 128 publications

(109 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Active second stage of labour was defined as commencement of active pushing until birth of the infant. The exclusive practice in Finland is of lateral episiotomy type [11], contrasting with more common use of mediolateral or midline episiotomy in other parts of the world.…”

Section: Methodsmentioning

confidence: 99%

The Association of Episiotomy with Obstetric Anal Sphincter Injury–A Population Based Matched Cohort Study

et al. 2014

View full text Add to dashboard Cite

ObjectivesTo estimate the independent association of episiotomy with obstetric anal sphincter injuries (OASIS) using first a cross-sectional and then a matched pair analysis.DesignA matched cohort.SettingData was gathered from the Finnish Medical Birth Register from 2004–2011.PopulationAll singleton vaginal births (n = 303,758).MethodsWomen resulting matched pairs (n = 63,925) were matched based on baseline risk of OASIS defined based on parity (first or second/subsequent vaginal births), age, birth weight, mode of delivery, prior caesarean section, and length of active second stage of birth.ResultsIn cross-sectional analysis episiotomy was associated with a 12% lower incidence of OASIS (adjusted odds ratio (aOR) 0.88, 95% confidence interval (CI) 0.80 to 0.98) in first vaginal births and with a 132% increased incidence of OASIS in second or subsequent vaginal births (aOR 2.32, 95% CI 1.77 to 3.03). In matched pair analysis episiotomy was associated with a 23% (aOR 0.77, 95% CI 0.69 to 0.86) lower incidence of OASIS in first vaginal births and a 61% (aOR 1.61, 95% CI 1.14 to 2.29) increased incidence of OASIS in second or subsequent vaginal births compared to women who gave birth without an episiotomy. The matched pair analysis showed a 12.5% and a 31.6% reduction in aORs of OASIS associated with episiotomy, respectively.ConclusionsA matched pair analysis showed a substantial reduction in the aORs of OASIS with episiotomy, due to confounding by indication. This indicates that results of observational studies evaluating an association between episiotomy and OASIS should be interpreted with caution.

show abstract

Section: Methodsmentioning

confidence: 99%

The Association of Episiotomy with Obstetric Anal Sphincter Injury–A Population Based Matched Cohort Study

et al. 2014

View full text Add to dashboard Cite

show abstract

“…While some authors have defined mediolateral episiotomies as those at 60°at the time of cutting [68,69], others have suggested an angle of >30°from the midline as the criterion [70]. The problem with these definitions is that there was no accurate way of measuring these angles.…”

Section: Angle Of the Episiotomymentioning

confidence: 99%

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

2015

View full text Add to dashboard Cite

show abstract

“…Lateral episiotomy, the exclusive episiotomy technique practiced in Finland, is when an incision is made to the vaginal introitus 1 or 2 cm lateral to the midline and directed towards the ischial tuberosity 10. Our previous work demonstrated that lateral episiotomy was associated with a lower OASIS incidence in first births and a higher rate in second and subsequent births,11 but use of episiotomy had declined substantially over the decade to 2007 among both women with first vaginal births and multiparous women as the incidence of OASIS increased 12.…”

Section: Introductionmentioning

confidence: 99%

Changing associations of episiotomy and anal sphincter injury across risk strata: results of a population-based register study in Finland 2004–2011

et al. 2013

View full text Add to dashboard Cite

ObjectivesTo evaluate the changing association between lateral episiotomy and obstetric anal sphincter injury (OASIS) for women with low and high baseline risk of OASIS.DesignA population-based register study.SettingData gathered from the Finnish Medical Birth Register for the years 2004−2011.ParticipantsAll women with spontaneous vaginal or vacuum-assisted singleton births in Finland (n=384 638).Main outcome measureOASIS incidence.ResultsDuring the study period, the incidence of OASIS increased from 1.3% to 1.7% in women with first vaginal births, including women admitted for first vaginal birth after a prior caesarean section and from 0.1% to 0.3% in women with at least one prior birth, whereas episiotomy rates declined from 56.7% to 45.5% and 10.1– 5.3%, respectively. At the study onset, when episiotomy was used more widely, it was negatively associated with OASIS in women with first vaginal births, but as episiotomy use declined it became positively associated with OASIS. Women with episiotomy were complicated by OASIS with clearly higher risk scores than women without episiotomy suggesting that episiotomy was clearly protective against OASIS. OASIS occurred with lower mean risk scores among women with and without episiotomy over time. However, OASIS incidences increased only among women with episiotomy, whereas it decreased or remained among women without episiotomy.ConclusionsThe cross-over effect between episiotomy and OASIS could be explained by increasing disparity in baseline OASIS risk between treated and untreated women, since episiotomy use declined most in women at low OASIS risk. Episiotomy rate can be safely reduced in low-risk women but interestingly along with the policy change the practice to cut the episiotomy became less protective among high-risk women.

show abstract

Classification of episiotomy: towards a standardisation of terminology

Cited by 128 publications

References 43 publications

The Association of Episiotomy with Obstetric Anal Sphincter Injury–A Population Based Matched Cohort Study

The Association of Episiotomy with Obstetric Anal Sphincter Injury–A Population Based Matched Cohort Study

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

Changing associations of episiotomy and anal sphincter injury across risk strata: results of a population-based register study in Finland 2004–2011

Contact Info

Product

Resources

About