The role of maternal age and episiotomy in the risk of anal sphincter tears during childbirth

Gerdin, Eva; Sverrisdottir, Gudlaug; Badi, Amal; Carlsson, Björn; Graf, Wilhelm

doi:10.1111/j.1479-828x.2007.00739.x

Cited by 27 publications

(12 citation statements)

References 42 publications

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“…This is in agreement with the evidence that episiotomy decreases the risk of OASIS during instrumental delivery . Episiotomy is more protective when performed with instrumental versus spontaneous delivery …”

Section: Discussionsupporting

confidence: 91%

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A comparative study of obstetric anal sphincter injuries in vaginal deliveries of twins and singleton pregnancies

Doumouchtsis

Fahmay

Sedgwick

et al. 2018

Neurourology and Urodynamics

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Section: Discussionsupporting

confidence: 91%

“…23 Episiotomy is more protective when performed with instrumental versus spontaneous delivery. 24 In the present study, women delivering twins had a higher rate of instrumental deliveries, which is a well-recognized risk factor for OASIS. 25 However, the incidence of OASIS was conversely lower in this group.…”

Section: Discussionsupporting

confidence: 46%

A comparative study of obstetric anal sphincter injuries in vaginal deliveries of twins and singleton pregnancies

Doumouchtsis

Fahmay

Sedgwick

et al. 2018

Neurourology and Urodynamics

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“…The non-routine practice of episiotomies, among other recommendations, has been promoted within this care framework. Our assessment confirms, as found in other studies, that 1 st degree tears, considered benign lesions that do not require repair, are the most frequent occurrence in births where an episiotomy has not been performed [22][23][24] and that 2 nd degree tears are also more frequent among births without episiotomies, but the restrictive use of an episiotomy has prevented a greater proportion of women having had a surgical incision as opposed to a minor tear [25]. Finally, the study revealed how the restrictive use of episiotomies reduces their percentage without compromising the safety of women or newborns [26,27].…”

Section: Discussionsupporting

confidence: 91%

Vaginal Delivery Care, Episiotomy Performance and Examination of Severe Perineal Tears: Cross-Sectional Study in 43 Public Hospitals

Escuriet¹,

Pueyo²,

García-Lausín³

et al. 2017

OGIJ

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Submit Manuscript | http://medcraveonline.com This approach became the project for normal birth assistance, gradually introduced into healthcare practice across the region of Catalonia. This work developed via three specific courses of action aimed at improving the infrastructure in maternity wards in hospitals, raising professionals' awareness and promoting women's participation in maternity care. All of these actions are coordinated by the Catalan Ministry of Health in order to involve all stakeholders and achieve greater consensus in promoting a model of normal childbirth care that is based on known recorded services the profile of the professional best practice.In 2013, a maternity care assessment was performed to explore obstetric interventions conducted on singleton, full-term deliveries in all hospitals in 2014 in Catalonia [2]. In our environment care provided at birth in women with normal pregnancy is assumed mostly by midwives, but the exact proportion of births attended by midwives is not known. The assessment revealed, among other things, a downward trend in the performance of episiotomies in public hospitals and, further, no significant increase in the incidence of severe perineal tears [3]. Based on this evaluation, new lines of research were undertaken to respond to aspects of maternal and child health requiring improvement but for which the information needed for planning effective services currently does not exist. It has been shown that midwife-led care during low/medium risk pregnancy, labour, delivery and postpartum is associated with benefits for mothers and newborns, with no Research ArticleObstet Gynecol Int J 2017, 7(6): 00270 AbstractIntroduction: In recent years work has been done in the public health system in Catalonia in order to achieve consensus in promoting a model of normal childbirth care. This study aims to ascertain the proportion of singleton, full-term vaginal non-instrumental births attended in public hospitals for which an episiotomy was performed and the incidence of severe perineal tears. Methodology:Descriptive cross-sectional study of all singleton births between 37 and 41 completed weeks of gestation attended in public hospitals (2013)(2014). Births were grouped into two groups "deliveries with episiotomy" and "deliveries without episiotomy". Hospitals were grouped by level of complexity (I to III -according to the Catalonia health department classification). The relationship between qualitative variables was analysed using a chi-square test and the T-student test was used for quantitative variables; a p value equal to or lower than 0.005 was considered significant. Results: Data were collected from 53770 births. The total percentage of perineal tears was 35.7% and the total of severe tears was 0.8%. No significant differences in the mean proportion of severe perineal tears among different types of hospitals or between the two groups. The regression analysis shows that the birth weight of the newborn is the only variable that increases the risk of experiencing a seve...

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“…In addition to a higher risk of anal sphincter damage in nulliparous women, we found a lower rate of episiotomy among nulliparous women who planned home birth [50]. The literature is inconclusive about the association between episiotomy and anal sphincter rupture [51, 52]. However, restrictive use of episiotomy has been recommended, as this is associated with less severe perineal damage [53].…”

Section: Discussionmentioning

confidence: 99%

Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands

Bolten

Jonge

Zwagerman

et al. 2016

BMC Pregnancy Childbirth

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BackgroundThe use of interventions in childbirth has increased the past decades. There is concern that some women might receive more interventions than they really need. For low-risk women, midwife-led birth settings may be of importance as a counterbalance towards the increasing rate of interventions. The effect of planned place of birth on interventions in the Netherlands is not yet clear. This study aims to give insight into differences in obstetric interventions and maternal outcomes for planned home versus planned hospital birth among women in midwife-led care.MethodsWomen from twenty practices across the Netherlands were included in 2009 and 2010. Of these, 3495 were low-risk and in midwife-led care at the onset of labour. Information about planned place of birth and outcomes, including instrumental birth (caesarean section, vacuum or forceps birth), labour augmentation, episiotomy, oxytocin in third stage, postpartum haemorrhage >1000 ml and perineal damage, came from the national midwife-led care perinatal database, and a postpartum questionnaire.ResultsWomen who planned home birth more often had spontaneous birth (nulliparous women aOR 1.38, 95 % CI 1.08–1.76, parous women aOR 2.29, 95 % CI 1.21–4.36) and less often episiotomy (nulliparous women aOR 0.73, 0.58–0.91, parous women aOR 0.47, 0.33–0.68) and use of oxytocin in the third stage (nulliparous women aOR 0.58, 0.42–0.80, parous women aOR 0.47, 0.37–0.60) compared to women who planned hospital birth. Nulliparous women more often had anal sphincter damage (aOR 1.75, 1.01–3.03), but the difference was not statistically significant if women who had caesarean sections were excluded. Parous women less often had labour augmentation (aOR 0.55, 0.36–0.82) and more often an intact perineum (aOR 1.65, 1.34–2.03). There were no differences in rates of vacuum/forceps birth, unplanned caesarean section and postpartum haemorrhage >1000 ml.ConclusionsWomen who planned home birth were more likely to give birth spontaneously and had fewer medical interventions.

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The role of maternal age and episiotomy in the risk of anal sphincter tears during childbirth

Abstract: There are several independent risk factors that should be considered when making decisions regarding delivery mode. Maternal age and episiotomy in non-instrumental delivery are two of these.

Cited by 27 publications

References 42 publications

A comparative study of obstetric anal sphincter injuries in vaginal deliveries of twins and singleton pregnancies

A comparative study of obstetric anal sphincter injuries in vaginal deliveries of twins and singleton pregnancies

Vaginal Delivery Care, Episiotomy Performance and Examination of Severe Perineal Tears: Cross-Sectional Study in 43 Public Hospitals

Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands

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