Impact of episiotomy on the urogenital hiatus using transperineal ultrasound

Garriga, Jordi Cassadó; Ruiz, Ana Carmona; Isern, Antoni Pessarrodona; Carballeira, Mónica Rodríguez; Serena, Esther Esteve; Manau, Pablo García; Esteve, Marta Valls; Galofré, Eva Huguet

doi:10.1002/nau.23322

Cited by 3 publications

(1 citation statement)

References 30 publications

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“…To begin with, episiotomy might be detrimental with respect to urinary incontinence symptoms ( 5 ). In a study conducted to assess the impact of episiotomy on the urogenital hiatus using transperineal ultrasound, the urogenital hiatal area was altered by episiotomy ( 6 ). In contrary, indicated use of episiotomy resulted in a significant decrease in third and fourth degree lacerations in a population-based observational study in Texas, United States of America ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis

et al. 2022

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BackgroundEpisiotomy, a surgical procedure that enlarges the vaginal opening during childbirth, was common practice until the early 2000s. Other sources, including the World Health Organization (WHO), advocate for the selective use of episiotomy. Episiotomy rates, on the other hand, have remained high in developing countries, while declining in developed countries. As a result, the current study sought to determine the overall prevalence of episiotomy in Africa as well as the risk factors associated with its practice.MethodsArticles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 14 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. A random-effects meta-analysis model was used to determine the pooled prevalence of episiotomy. A heterogeneity test was conducted using I-Squared (I2) statistics. Egger's test and funnel plots were conducted to detect publication bias. Subgroup analysis was also conducted. Association was expressed through a pooled odds ratio (OR) with a 95% Confidence Interval (CI).ResultA total of 21 studies with 40,831 participants were included in the systematic review and meta-analysis. The pooled prevalence of episiotomy practice was 41.7% [95% CI (36.0–47.4), I2 = 99.3%, P < 0.001). Primiparity [OR: 6.796 (95% CI (4.862–9.498)), P < 0.001, I2: 95.1%], medical doctors- assisted delivery [OR: 3.675 (95% CI (2.034–6.640)), P < 0.001, I2: 72.6%], prolonged second stage of labor [OR: 5.539 (95% CI (4.252–7.199)), P < 0.001, I2: 0.0%], using oxytocin [OR: 4.207 (95% CI (3.100–5.709)), P < 0.001, I2: 0.0%], instrument -assisted vaginal delivery [OR: 5.578 (95% CI (4.285–7.260)), P < 0.001, I2: 65.1%], and macrosomia [OR: 5.32 (95% CI (2.738–10.339)), P < 0.001, I2: 95.1%] were factors associated with episiotomy practice.ConclusionIn this review, the prevalence of episiotomy among African parturients was high. A selective episiotomy practice should be implemented to reduce the high episiotomy rates.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021293382, identifier: CRD42021293382.

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Section: Introductionmentioning

confidence: 99%

Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis

et al. 2022

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New approach to the evaluation of perineal measurements to predict the likelihood of the need for an episiotomy

et al. 2018

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Association of levator injury and urogynecological complaints in women after their first vaginal birth with and without mediolateral episiotomy

Speksnijder

Oom

Bavel

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: Pelvic organ prolapse is a common health problem in women and has a negative influence on quality of life. A major cause of pelvic organ prolapse is levator injury. OBJECTIVE: The objective of the study was to evaluate the association of mediolateral episiotomy with levator injury (levator avulsion, ballooning, or combined) and urogynecological complaints. STUDY DESIGN: A prospective observational cohort study was performed in 204 primiparous women with a spontaneous vaginal delivery without anal sphincter tear in a general hospital between 2012 and 2015. One hundred three of these women had had a mediolateral episiotomy. Validated urogynecological questionnaires and transperineal 3-dimensional/ 4-dimensional ultrasound were completed after delivery. Outcome measures were levator avulsion, ballooning (hiatal area of more than 25 cm 2), and urogynecological questionnaire scores. Statistical analysis was performed using univariate and multiple logistic regression analysis. RESULTS: The median time at investigation after vaginal delivery was 13 months (range 6e33). Levator injury (avulsion, ballooning, or combined) was identified in 35 of the 103 women who had undergone mediolateral episiotomy (40.0%) and 33 of the 101 women without episiotomy (32.7%) (P ¼ .69). No differences were found in the incidence of levator avulsion 27 (26.7%) vs 23 (22.8%) (P ¼ .53) or in levator ballooning (20 [19.4%] vs 23 [22.8%] (P ¼ .58) between both groups. There was an association between longer duration of the second stage of labor and the incidence of levator avulsion (odds ratio, 1.24 [95% confidence interval, 1.01e1.52]). Nonocciput anterior fetal position increased the risk of levator ballooning and levator injury (odds ratio, 10.19 [95% confidence interval, 1.89e54.91] and odds ratio, 12.16 [95% confidence interval, 1.41e104.38], respectively). No differences in urogynecological complaints were found. CONCLUSION: Mediolateral episiotomy is not associated with the occurrence of levator injury or urogynecological complaints in women with a spontaneous vaginal delivery who did not obtain an anal sphincter injury. Levator injury was associated with a prolonged second stage of labor and a nonocciput anterior fetal position.

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Impact of episiotomy on the urogenital hiatus using transperineal ultrasound

Abstract: In normal vaginal delivery, neither the area of the urogenital hiatus nor its difference at rest and during contraction, as measured by ultrasound, were modified by performing an episiotomy.

Cited by 3 publications

References 30 publications

Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis

Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis

New approach to the evaluation of perineal measurements to predict the likelihood of the need for an episiotomy

Association of levator injury and urogynecological complaints in women after their first vaginal birth with and without mediolateral episiotomy

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