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

Marschalek, Marie-Louise; Worda, Christof; Kuessel, Lorenz; Koelbl, Heinz; Oberaigner, Willi; Leitner, Hermann; Marschalek, Julian; Husslein, H

doi:10.1111/birt.12346

Cited by 29 publications

(27 citation statements)

References 42 publications

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“…Similar to previous studies [41, 46, 47], an increase in OASIS was observed. This rise could be associated with the decrease in episiotomy rates [41], but may also be influenced by the increases in instrumental delivery and nulliparity which are known risk factors for OASIS [8].…”

Section: Discussionsupporting

confidence: 90%

A novel classification for evaluating episiotomy practices: application to the Burgundy perinatal network

Desplanches

Szczepanski²,

Cottenet

et al. 2019

BMC Pregnancy Childbirth

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Background: Though the rate of episiotomy has decreased in France, the overall episiotomy rate was 20% in the 2016 national perinatal survey. We aimed to develop a classification to facilitate the analysis of episiotomy practices and to evaluate whether episiotomy is associated with a reduction in the rate of obstetric anal sphincter injuries (OASIS) for each subgroup. Methods: This population-based study included all the deliveries that occurred in the Burgundy Perinatal Network from 2011 to 2016. The main outcome was episiotomy, which was identified thanks to the French Common Classification of Medical Procedures. An ascending hierarchical cluster analysis was performed to build the classification. A clinical audit using the classification was conducted yearly in all obstetric units. The episiotomy rates were described throughout the study period for each subgroup of the classification. The OASIS rates were evaluated by subgroup and the association between mediolateral episiotomy and OASIS was investigated for each subgroup. Results: Our analyses included 81,290 pregnant women. The classification comprised 7 subgroups: (1) nulliparous single cephalic at term, (2) nulliparous single cephalic at term with instrumental delivery, (3) multiparous single cephalic at term, (4) multiparous single cephalic at term with instrumental delivery, (5) all preterm deliveries (< 37 weeks gestation), (6) all breech deliveries, (7) all multiple deliveries. Episiotomy rates ranged from 6.2% in Group 3 to 40.9% in Group 2. From 2011 to 2016, every group except breech deliveries experienced a significant decrease in episiotomy rates, ranging from − 28.1 to − 61.0%. The prevalence of OASIS was the highest in Groups 2 (3.0%) and 4 (2.2%). Overall OASIS rates did not significantly differ with episiotomy use (P = 0.25). However, we found that the use of episiotomy was associated with a reduction in OASIS rates in Groups 1 and 2 (odds ratio 0.6 [95% CI 0.4-0.9] and 0.4 [0.3-0.5], respectively). This reduction was only observed in Group 4 with forceps delivery (odds ratio 0.4 [0.1-0.9]). Conclusion: We developed the first classification for the evaluation of episiotomy practices based on 7 clinically relevant subgroups. This easy-to-use tool can help obstetricians and midwives improve their practices through self-assessment.

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Section: Discussionsupporting

confidence: 90%

A novel classification for evaluating episiotomy practices: application to the Burgundy perinatal network

Desplanches

Szczepanski²,

Cottenet

et al. 2019

BMC Pregnancy Childbirth

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“…Perineal edema is associated with perineal pain and postpartum discomfort after vaginal delivery. Rapid recovery from perineal edema allows for the resumption of maternal activities of daily living, such as lying down, sitting, walking, infant care, breastfeeding, and urination 429. Our study showed that a high percentage of women in the HAase injection group had improved perineal edema at 24 hours, which suggests that HAase injections improve tissue diffusion and the resorption rate of excess fluid.…”

Section: Discussionmentioning

confidence: 52%

“…The reported incidence of perineal trauma during vaginal delivery is approximately 85%, but can vary in different settings, depending on clinical practice and conditions during vaginal delivery 2. Anal sphincter injuries, which are the most severe perineal trauma events, have gradually increased in number over the last several decades, with incidence rates ranging from 4.1% to 16.0% in several population-based studies 34. Perineal trauma during vaginal delivery has been shown to be associated with significant maternal morbidities, including blood loss, perineal pain, infection, dyspareunia, urinary incontinence, flatus, and fecal incontinence, and to lead to the development of comorbidities, including sexual dysfunction, pelvic organ prolapse, and rectovaginal and vesicovaginal fistulas 356.…”

Section: Introductionmentioning

confidence: 99%

Randomized, Double-Blind, Placebo-Controlled Trial on the Efficacy of Hyaluronidase in Preventing Perineal Trauma in Nulliparous Women

et al. 2020

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PurposeHyaluronidase (HAase) has many uses in medicine, and reports suggest that it affects perineal tissue during fetal passage through the vaginal canal. However, its potential use for preventing perineal trauma has yet to be determined. This study sought to evaluate the efficacy and safety of perineal HAase injections in reducing perineal trauma during vaginal delivery.Materials and MethodsA multi-center, double-blind, placebo-controlled, randomized study was conducted from January 2016 to March 2017. Nulliparous women who planned to undergo vaginal delivery were recruited, and the enrolled women were randomly assigned to the HAase injection group (HAase injection, 5000 IU, n=75) or the control group (normal saline injection, n=73). The degree of perineal laceration, rate of episiotomy, and grade of perineal edema at 1 hour and 24 hours after spontaneous vaginal delivery were compared between the two groups.ResultsA total of 148 women who underwent vaginal delivery were recruited. No significant differences were observed between the HAase injection and control groups in the rates of perineal laceration (p=0.422). Perineal edema significantly decreased 24 hours after delivery in the women treated with perineal HAase injections, compared to women in the control group (p=0.008). The overall incidences of adverse events, such as redness of the injection site, infection, and wound dehiscence, were similar between the two groups.ConclusionHAase injections in nulliparous women afforded no reductions in the rates of perineal lacerations and episiotomy. However, the use of perineal HAase injections did reduce perineal edema without severe adverse events.

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“…1 In our analysis, the main supine position was the semi-recumbent position, with 53.1% of all births, and not the lithotomy position. On the other hand, Marschalek et al, 2 analyzing a national database, reported that the birth position had no effect on OASIs. Our interpretation has raised questions that range from a long history of births in the horizontal position to the effective approaches for perineal protection in upright positions.…”

Section: Discussionmentioning

confidence: 98%

“…The best maternal position adopted during the pelvic phase to avoid perineal damage is an issue that is still controversial, depending on a set of multifactorial predictors and specific subgroups of analysis. [1][2][3] High rates of obstetric anal sphincter injuries (OASIs) among women giving birth in the lithotomy position were reported in a population-based study 1 in Sweden on term non-instrumental births without episiotomy. However, another population-based research 2 in Austria, including primiparous term births, did not prove any effect of the birth positions on OASIs.…”

Section: Introductionmentioning

confidence: 99%

Do We Know How to Avoid OASIs in Non-Supine Birth Positions? A Retrospective Cohort Analysis

Reis

Pereira

Vianini

et al. 2019

Rev Bras Ginecol Obstet

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Objective To evaluate the association between the upright and supine maternal positions for birth and the incidence of obstetric anal sphincter injuries (OASIs). Methods Retrospective cohort study analyzed the data of 1,728 pregnant women who vaginally delivered live single cephalic newborns with a birth weight of 2,500 g. Multiple regression analyses were used to investigate the effect of the supine and upright positions on the incidence of OASIs after adjusting for risk factors and obstetric interventions. Results In total, 239 (13.8%) births occurred in upright positions, and 1,489 (86.2%) in supine positions. Grade-III lacerations occurred in 43 (2.5%) patients, and grade-IV lacerations occurred in 3 (0.2%) women. Supine positions had a significant protective effect against severe lacerations, odds ratio [95% confidence interval]: 0,47 [0.22–0.99], adjusted for the use of forceps 4.80 [2.15–10.70], nulliparity 2.86 [1.44–5.69], and birth weight 3.30 [1.56–7.00]. Anesthesia (p < 0.070), oxytocin augmentation (p < 0.228), shoulder dystocia (p < 0.670), and episiotomy (p < 0.559) were not associated with the incidence of severe lacerations. Conclusion Upright birth positions were not associated with a lower rate of perineal tears. The interpretation of the findings regarding these positions raised doubts about perineal protection that are still unanswered.

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

Cited by 29 publications

References 42 publications

A novel classification for evaluating episiotomy practices: application to the Burgundy perinatal network

A novel classification for evaluating episiotomy practices: application to the Burgundy perinatal network

Randomized, Double-Blind, Placebo-Controlled Trial on the Efficacy of Hyaluronidase in Preventing Perineal Trauma in Nulliparous Women

Do We Know How to Avoid OASIs in Non-Supine Birth Positions? A Retrospective Cohort Analysis

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