Management of the Perineum during Delivery with the Kiwi Omnicup: Effects of Mediolateral Episiotomy on Anal Sphincter Tears in Nulliparous Women

Kimberger, Oliver; Käfer, Andreas; Husslein, Peter; Bodner‐Adler, Barbara

doi:10.1159/000478930

Cited by 13 publications

(10 citation statements)

References 34 publications

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“…The number needed to treat to prevent one obstetric anal sphincter injury during vacuum‐assisted delivery was found to be 50. This finding is supported by previous studies, which reported a decrease in obstetric anal sphincter injuries when episiotomy was used in operative vaginal deliveries 8, 25, 28, 29. Jangö et al report a number needed to treat of 23 mediolateral episiotomies and Raisänen et al report a number needed to treat of 66 lateral episiotomies to prevent one case of obstetric anal sphincter injury in vacuum‐assisted deliveries, thus favoring more frequent use of episiotomy in such cases 28, 30.…”

Section: Discussionsupporting

confidence: 90%

“…This finding is supported by previous studies, which reported a decrease in obstetric anal sphincter injuries when episiotomy was used in operative vaginal deliveries. 8,25,28,29 Jangö et al report a number needed to treat of 23 mediolateral episiotomies and Raisänen et al report a number needed to treat of 66 lateral episiotomies to prevent one case of obstetric anal sphincter injury in vacuum-assisted deliveries, thus favoring more frequent use of episiotomy in such cases. 28,30 In forceps-assisted vaginal delivery, we could not find a protective effect of mediolateral episiotomy.…”

Section: Adjusted a Or (95% Ci)mentioning

confidence: 99%

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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: Discussionsupporting

confidence: 90%

Section: Adjusted a Or (95% Ci)mentioning

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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“…Perineal injuries mean injury to perineal muscles or anal sphincter and may be to the labia, vagina, urethra, and clitoris. This may occur spontaneously during a vaginal birth, or from the trauma of an operative delivery or by an episiotomy (Bodner-Adler et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Rate of Episiotomy And Perineal Injuries during Vaginal Delivaries at Maternity Hospital in Duhok City

Fatah

2019

juod

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Episiotomy is a surgical incision done at the end of the second stage of labor to expand the opening of the vagina to prevent tearing and injury of the perineum during the delivery of the baby. The aim of this study is to estimate the episiotomy and perineal injuries rates and the indication for episiotomy.A descriptive cross-sectional study was conducted retrospectively between the 1 st of Jan. 2018 till 31 of Dec. 2018 at Maternity Hospital in Duhok city. The data were obtained from the information in the case sheets of the women who attended this hospital for vaginal deliveries, the total number of vaginal deliveries was (12302) during that period. The results revealed that the episiotomy and perineal injuries rate was (23%), as the episiotomy rate was (14.7%) and perineal injuries rate was (8.3%) overall. The primiparous episiotomy rate was (40.3%) while multiparous episiotomy rate was (15.8%). The primiparas women were (52.3%) of the mothers who had episiotomy and perineal injuries, their episiotomy rate was (88.1%) and the perineal injuries rate was (11.9%). While the perineal injuries were more in multiparas mothers (62%) and episiotomy rate was (38%). The main indication of episiotomy was primigravida, which was done routinely in (71.8%). The rigid perineum, previous perineal tears, previous episiotomy and previous cesarean section C/S were the indication in (11.8%) of the mothers. The low and high birth weight were the indications in (7.5%) in those who needed episiotomy.Episiotomy and perineal injury (tear) rate was considered as acceptable rate even it is higher than what was reported in developed countries as well as the result revealed that episiotomy was minimizing the rate of perineal injury.

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“…Though several risk factors have been associated with OASI, including operative vaginal delivery, nulliparity, macrosomia, Asian race, shoulder dystocia, and episiotomy, these factors are often considered unmodifiable, particularly in light of the alternative—a cesarean birth. 9 10 11 12 13 The length of the second stage of labor has been associated with anal sphincter injury in some but not all studies, likely at least in part because of the difficulty in separating the impact of fetal malposition, operative vaginal delivery, and prolonged second stage that frequently cooccur. Given the recent emphasis on more permissive time limits for the second stage as a part of efforts to decrease primary cesarean deliveries, 14 understanding the relationship between second-stage length and anal sphincter injury is an important part of counseling women regarding risks and benefits of options for management in the second stage.…”

mentioning

confidence: 99%

Prolonged Second Stage of Labor and Anal Sphincter Injury in a Contemporary Cohort of Term Nulliparas

et al. 2020

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Objective This study aimed to assess whether a prolonged second stage of labor is an independent predictor of obstetric anal sphincter injury (OASI) in a contemporary cohort of nulliparous and term parturients, and to evaluate whether predelivery factors can accurately predict OASI. Study Design This was a nested case-control study within a cohort of consecutive nulliparous term parturients with a singleton gestation who underwent a vaginal delivery at a single institution between January 2014 and January 2015. Cases were defined as women with a third- or fourth-degree laceration at the time of delivery, and controls were women without a third- or fourth-degree laceration. A prolonged second stage was defined as a second stage of ≥3 hours. Univariable and multivariable regression analyses were performed to examine the relationship between prolonged second stage of labor and third- or fourth-degree lacerations. Receiver operator curves were developed to assess the predictive capacity of predelivery information for third- and fourth-degree lacerations. Results Of 1,197 births, 63 women had third- or fourth-degree lacerations (5.3%). With each additional hour of the second stage, the rate of OASI increased, with 2.9% of women with a second stage of <1 hour with OASI, 3.5% between 1 and 2 hours, 5.7% between 2 and 3 hours, 7.8% between 3 and 4 hours, 16.1% between 4 and 5 hours, and 28.6% among women with a second stage length >5 hours (p < 0.001). In multivariable regression analysis, operative vaginal delivery (adjusted odds ratio [aOR] = 5.92, 95% confidence interval [CI]: 3.17–11.07) and a prolonged second stage (aOR = 1.92, 95% CI: 1.06–3.51) were independent predictors of third- and fourth-degree lacerations. A predictive model was developed from these results (area under the curve [AUC] = 0.75, 95% CI: 0.68–0.81). Conclusion Prolonged second stage of labor is a predictor of OASI, after adjustment for operative vaginal delivery. A model using predelivery risk factors has a reasonable prediction of OASI. Key Points

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Management of the Perineum during Delivery with the Kiwi Omnicup: Effects of Mediolateral Episiotomy on Anal Sphincter Tears in Nulliparous Women

Cited by 13 publications

References 34 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

Rate of Episiotomy And Perineal Injuries during Vaginal Delivaries at Maternity Hospital in Duhok City

Prolonged Second Stage of Labor and Anal Sphincter Injury in a Contemporary Cohort of Term Nulliparas

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