Risk factors for obstetric anal sphincter injuries (OASIS) during vacuum extraction delivery in a university affiliated maternity hospital

Segal, David; Baumfeld, Yael; Yahav, Lior; Yohay, David; Geva, Yael; Press, Fernanda; Weintraub, Adi Y.

doi:10.1080/14767058.2018.1514376

Cited by 11 publications

(10 citation statements)

References 16 publications

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“…Furthermore, the OASI rate in our study is low compared with previous publications from other countries, and indeed is almost the lowest reported among the countries of the OECD (Organisation for Economic Co‐operation and Development), possibly limiting the generalizability of our results 24 . Nevertheless, our results are in line with published studies from our country of practice 25 . We cannot exclude the possibility that unstudied factors were associated with OASI occurrence.…”

Section: Discussionsupporting

confidence: 87%

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A dynamic prediction score for obstetric anal sphincter injury among nulliparous women delivering vaginally

Meyer

Schwartz

Horesh

et al. 2021

Intl J Gynecology & Obste

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Objective To develop a risk score for obstetric anal sphincter injury (OASI) occurrence among nulliparous women delivering vaginally, based on data available at admission for delivery and as labor progresses. Methods A retrospective study of all nulliparous women who delivered vaginally between March 2011 and January 2021. Characteristics were compared between OASI and no‐OASI groups. Multivariable analyses were performed to identify independent risk factors for OASI occurrence. Results OASI occurred in 453 (1.7%) of 26 081 women who met the inclusion criteria. The following variables were independently associated with OASI: maternal height (adjusted odds ratio [aOR] 0.97, 95% confidence interval (CI) 0.95–0.99), hypertensive disorders (aOR 1.74, 95% CI 1.03–2.95), sonographic fetal weight estimation (aOR 1.00, 95% CI 1.00–1.00), second‐stage duration (aOR 1.00, 95% CI 1.00–1.00), occiput posterior position (aOR 2.87, 95% CI 1.79–4.62), and episiotomy performance (aOR 0.63, 95% CI 0.47–0.84). In a risk score based on variables available at admission for delivery, the presence of two factors was associated with 4.3% OASI risk. Upon incorporating intrapartum variables, the presence of two risk factors was associated with 2.9% OASI rate. Conclusion A dynamic risk score for OASI occurrence based on data available at admission for delivery and as delivery progresses can assist in counseling regarding OASI risk. A dynamic risk score for obstetric anal sphincter injury occurrence based on data available at admission for delivery and intrapartum was developed.

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Section: Discussionsupporting

confidence: 87%

“…24 Nevertheless, our results are in line with published studies from our country of practice. 25 We cannot exclude the possibility that unstudied factors were associated with OASI occurrence. Nevertheless, we have evaluated a wide range of variables.…”

Section: Discussionmentioning

confidence: 96%

A dynamic prediction score for obstetric anal sphincter injury among nulliparous women delivering vaginally

Meyer

Schwartz

Horesh

et al. 2021

Intl J Gynecology & Obste

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“…8 This decrease in the risk for OASIS associated with vacuum extraction may be attributed to the use of improved techniques or to more appropriate selection criteria that enables more accurate identification of women who may benefit from a vacuum delivery without the associated morbidity. 41 Another possible explanation for this decreasing trend can be the use of a new kind of vacuum, namely the 'kiwi vacuum cup.' This vacuum was introduced in 2008 and was gradually integrated along with the old vacuum during the third time period of this study.…”

Section: Resultsmentioning

confidence: 99%

Temporal trends in the incidence of and associations between the risk factors for obstetrical anal sphincter injuries

Ekstein-Badichi

Shoham‐Vardi

Weintraub

2021

American Journal of Obstetrics & Gynecology MFM

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BACKGROUND: Obstetrical anal sphincter injuries are an important complication of vaginal deliveries that may result in short-and long-term pelvic floor morbidity and a diminished quality of life in young, healthy women. The prevalence of obstetrical anal sphincter injuries ranges from 0.1% to 8.7%. Over recent years, there seems to be a trend of increasing occurrence of obstetrical anal sphincter injuries worldwide. It is unclear why the rates are rising. Previous studies have examined the effect of different risk factors on the prevalence of obstetrical anal sphincter injuries. The change in the incidence of some risk factors for obstetrical anal sphincter injuries can partially explain the overall increase in obstetrical anal sphincter injuries. There is no previous study that explored the impact of the changes of individual risk factors over time on the risk for obstetrical anal sphincter injuries. OBJECTIVE: The main aim of this study was to examine the temporal trends in the prevalence and odds ratio of the major risk factors known to be associated with obstetrical anal sphincter injuries in the period from 1988 to 2016. STUDY DESIGN: This was a retrospective cohort study that included all women who underwent vaginal deliveries between 1988 and 2016 at a tertiary university medical center. The time intervals were divided into 4 periods (1988e1997, 1998e2007, 2008e2016, and the total time from 1988 to 2016) and the incidence of each risk factor was calculated for each time period. Correlation models and regression analysis were performed to examine the association between obstetrical anal sphincter injuries and the different risk factors over time. Furthermore, the trends in the odds ratios of the important risk factors over the time periods were evaluated using a multivariate regression analysis in which the primiparous women were separated from the multiparous women. RESULTS: During the study period, there were 295,668 vaginal deliveries. Of these, 591 women were diagnosed with obstetrical anal sphincter injuries (0.2%). The significant risk factors for obstetrical anal sphincter injuries (P<.05) in the multivariable analysis were the following: primiparity, vaginal birth after cesarean delivery, vacuum extraction, and a birthweight of >4 kg. There was a significant (P<.05) increase in the incidence over the study period for the following risk factors: primiparity, vaginal birth after cesarean delivery, and vacuum extraction. No change was found in the incidence of the risk factor of a birthweight of >4 kg. In addition, we found a strengthening of the association between vaginal birth after cesarean delivery and macrosomia with obstetrical anal sphincter injuries, as opposed to a decline in the relative contribution of vacuum extraction to the overall risk for obstetrical anal sphincter injuries. Moreover, we found that obstetrical anal sphincter injuries among primiparous women increased 7-fold over the study period but was unchanged among multiparous women. CONCLUSION: We have shown significant (P<.05) t...

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“…In the literature, forceps for operative vaginal delivery was associated with an increased risk of OASIS [44]. Similarly, many studies reported even vacuum extraction as a significant risk factor for perineal trauma [12,45]. However, Ramm et al [27] included a cohort of 22822 vaginal deliveries reporting a 4-6 times higher OASIS rate among patients who underwent forceps-assisted deliveries than vacuum-assisted deliveries.…”

Section: Intrapartum Factorsmentioning

confidence: 99%

Risk factors for obstetric anal sphincter injuries during vaginal delivery: can we reduce the burden?

Porcari¹,

Garzon²,

Loreti³

et al. 2021

Clinical and Experimental Obstetrics & Gynecology

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Background: Third-and fourth-degree perineal tears are associated with significant discomfort and impact on women's quality of life after labor. We reviewed the literature on risk factors for obstetric anal sphincter injuries (OASIS), focusing on modifiable risk factors for OASIS to help obstetricians prevent them. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus using key search terms. We selected clinical studies, systematic reviews, and meta-analyses in English investigating antepartum and intrapartum factors associated with OASIS. Three researchers independently selected studies and documented outcomes. Results: We identified forty-two relevant articles for inclusion. Among antepartum factors, primiparity, neonatal birth weight, and ethnicity were associated with a higher risk of OASIS. Instrumental delivery, midline episiotomy, duration of the second stage of labor, persistent occiput posterior position, and labor augmentation were those intrapartum factors reported associated with OASIS. Conclusions: Multiple anteand intrapartum factors are associated with a higher risk of OASIS. The actual modifiable factor is episiotomy during the second stage of labor. However, literature reporting episiotomy associated with a reduction in OASIS prevalence during instrumental delivery is limited. These results may help obstetricians recognize women at higher risk of developing severe perineal tears and recommend further investigation on the role of episiotomy in an operative delivery.

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Risk factors for obstetric anal sphincter injuries (OASIS) during vacuum extraction delivery in a university affiliated maternity hospital

Abstract: OASIS is uncommon in our population. Vacuum extraction in nulliparous parturient is a significant risk factor for OASIS. Our results should be taken into account when managing nulliparous deliveries.

Cited by 11 publications

References 16 publications

A dynamic prediction score for obstetric anal sphincter injury among nulliparous women delivering vaginally

A dynamic prediction score for obstetric anal sphincter injury among nulliparous women delivering vaginally

Temporal trends in the incidence of and associations between the risk factors for obstetrical anal sphincter injuries

Risk factors for obstetric anal sphincter injuries during vaginal delivery: can we reduce the burden?

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