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Muraca GM, Desai A, Hébert V, Mann GK, Park M, Lisonkova S, Joseph KS. Variation in Episiotomy Use Among Nulliparous Individuals by Maternity Care Provider and Associated Rates of Obstetric Anal Sphincter Injury. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102415. [PMID: 38387834 DOI: 10.1016/j.jogc.2024.102415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To quantify variation in the association between episiotomy and obstetric anal sphincter injury (OASI) by maternity care provider in spontaneous and operative vaginal deliveries (SVDs and OVDs). METHODS Population-based retrospective cohort study of vaginal, term deliveries among nullipara in Canada (2004-2015). Adjusted rate ratios (ARRs) and 95% CIs were estimated using log-binomial regression to quantify the associations between episiotomy and OASI, stratified by care provider (obstetrician [OB], family physician [FP], or registered midwife [RM]) while adjusting for potential confounders. RESULTS The study included 631 642 deliveries. Episiotomy use varied by provider: among SVDs, the episiotomy rate was 19.6%, 14.4%, and 8.4% in the OB, FP, and RM groups, respectively. The rate of OASI was higher among SVDs with versus without episiotomy (5.8% vs 4.6%). Conversely, OASI occurred less frequently in operative vaginal deliveries with episiotomy (15.3%) compared with those without (16.7%). In all provider groups, the ARR for OASI was increased with episiotomy in SVD and decreased with episiotomy with forceps delivery. No differences in these associations were observed by provider except among vacuum delivery (ARR with episiotomy vs. without, OB: 0.88, 95% CI 0.84-0.92; FP: 0.89, 95% CI 0.83-0.96, RM: 1.22, 95% CI 1.02-1.48). CONCLUSIONS In nullipara, irrespective of maternity care provider, there is a positive association between episiotomy and OASI among SVDs and an inverse association between episiotomy and deliveries with forceps. The relationship between episiotomy and OASI is modified by maternity care providers among vacuum deliveries.
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Affiliation(s)
- Giulia M Muraca
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden.
| | - Anvi Desai
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Vanessa Hébert
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Gurkiran K Mann
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Meejin Park
- Department of Global Health, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Muraca GM, Ralph LE, Christensen P, D'Souza R, Geoffrion R, Lisonkova S, Joseph KS. Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked. BMJ 2023; 383:e073991. [PMID: 37857419 PMCID: PMC10585424 DOI: 10.1136/bmj-2022-073991] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Giulia M Muraca
- Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Sweden
| | | | - Penny Christensen
- Public representative, Birth Trauma Canada, Saint John, New Brunswick, Canada
| | - Rohan D'Souza
- Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Roxana Geoffrion
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Giroux M, Emslie E, Karreman E, Jabs C. Implementation of Episcissors-60 for Prevention of Obstetric Anal Sphincter Injuries (OASIS) in a Centre with Low Episiotomy Rates. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:410-416. [PMID: 37085090 DOI: 10.1016/j.jogc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether introduction of Episcissors-60 into a labour and birth unit would decrease the incidence of Obstetric Anal Sphincter Injuries (OASIS). METHODS A before-and-after quality improvement study was conducted between April 1, 2020 and March 31, 2021. All patients who had a vaginal delivery were included in this study. All healthcare providers who perform vaginal deliveries were offered an educational session. Episcissors-60 were then introduced into a labour and birth unit. The primary outcome measure was the change in incidence of OASIS before and after introduction of Episcissors-60. Secondary outcome measures were episiotomy rates before and after introduction of Episcissors-60, device-related adverse events, and provider satisfaction and feedback. Data was analyzed using chi-square tests, independent t-tests, and Mann-Whitney tests. RESULTS A total of 1383 vaginal deliveries occurred prior and 1254 vaginal deliveries after introduction of Episcissors-60. There was a decrease in the total OASIS rate from 7.37% of all vaginal deliveries prior to 5.37% after introduction of Episcissors-60 (P = .037). The episiotomy rate was 11.42% prior to and 9.97% after introduction of Episcissors-60 (P = .228). OASIS rate in women who had an episiotomy was 12.02% before and 13.60% after introduction of Episcissors-60 (P = .421). CONCLUSION Although introduction of Episcissors-60 was associated with a statistically significant decrease in total OASIS rate, there was no difference in OASIS rates within the subgroup that received an episiotomy. Therefore, reduction in the total OASIS rate in this study cannot be attributed to the use of Episcissors-60.
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Affiliation(s)
| | - Ethan Emslie
- College of Medicine, University of Saskatchewan, Regina, SK
| | - Erwin Karreman
- Research Department, Saskatchewan Health Authority, Regina, SK
| | - Corrine Jabs
- Department of Obstetrics and Gynecology, University of Saskatchewan, Regina, SK
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Episiotomy for Medical Indications during Vaginal Birth-Retrospective Analysis of Risk Factors Determining the Performance of This Procedure. J Clin Med 2022; 11:jcm11154334. [PMID: 35893429 PMCID: PMC9368956 DOI: 10.3390/jcm11154334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023] Open
Abstract
The WHO (World Health Organization) recommends that the percentage of perineal incisions should not exceed 10%, indicating that this is a good goal to achieve, despite the fact that it is still a frequently used medical intervention in Poland. The risk factors for perineal incision that have been analyzed so far in the literature allow, among others, to limit the frequency of performing this procedure. Are they still valid? Have there been new risk factors that we should take into account? We have conducted this study to find the risk factors for performing perineal incision that would reduce the frequency of this procedure. The aim of the study was to check whether the risk factors that were analyzed in the literature are still valid, to find new risk factors for perineal incisions and to compare them among Polish women. This was a single-center retrospective case-control study. The electronic patient records of Saint Sophia's Hospital in Warsaw, Poland, a tertiary hospital was used to create an anonymous retrospective database of all deliveries from 2015 to 2020. The study included the analysis of two groups, the study group of patients who had had an episiotomy, and the control group-patients without an episiotomy in cases where an episiotomy was indicated. A logistic regression model was developed to assess the risk factors for perineal laceration. Independent risk factors for episiotomy in labor include oxytocin use in the second stage of labor (OR (Odds Ratio) = 6.00; 95% CI (Confidence Interval): 4.76-7.58), the supply of oxytocin in the first and the second stage of labor (OR = 3.18; 95% CI: 2.90-3.49), oxytocin use in the first stage of labor (OR = 2.72; 95% CI: 2.52-3.51), state after cesarean section (OR = 2.97; 95% CI: 2.52-3.51), epidural anesthesia use (OR = 1.77; 95% CI: 1.62-1.93), male gender (OR = 1.10; 95% CI: 1.02-1.19), and prolonged second stage of labor (OR = 1.01; 95% CI: 1.01-1.01). A protective factor against the use of an episiotomy was delivery in the Birth Centre (OR = 0.43; 95% CI: 0.37-0.51) and mulitpara (OR = 0.31; 95% CI: 0.27-0.35). To reduce the frequency of an episiotomy, it is necessary consider the risk factors of performing this procedure in everyday practice, e.g., limiting the use of oxytocin or promoting alternative places of delivery.
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Hu Y, Lu H, Huang Q, Ren L, Wang N, Huang J, Yang M, Cao L. Risk factors for severe perineal lacerations during childbirth: A systematic review and meta‐analysis of cohort studies. J Clin Nurs 2022. [PMID: 35791260 DOI: 10.1111/jocn.16438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/24/2022] [Accepted: 06/20/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Yinchu Hu
- School of Nursing Peking University Beijing China
| | - Hong Lu
- School of Nursing Peking University Beijing China
| | - Qifang Huang
- School of Nursing Peking University Beijing China
| | - Lihua Ren
- School of Nursing Peking University Beijing China
| | - Na Wang
- School of Nursing Capital Medical University Beijing China
| | - Jing Huang
- School of Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care King's College London London UK
| | - Minghui Yang
- Department of Obstetrics and Gynecology First Affiliated Hospital of Kunming Medical University Kunming China
| | - Linlin Cao
- Department of Obstetrics and Gynecology Peking University Third Hospital Beijing China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital) Beijing China
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Perslev K, Mørch EJ, Jangö H. Increased risk of obstetric anal sphincter injury in women undergoing vaginal delivery after caesarean section: A systematic review and meta-analysis. BJOG 2022; 129:1961-1968. [PMID: 35596697 DOI: 10.1111/1471-0528.17227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/26/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is increased focus on obstetric anal sphincter injury (OASI) and there are several well-established risk factors such as birthweight, instrumental delivery and median episiotomy. Some studies have found increased risk of OASI in women delivering vaginally after a previous caesarean section (VBAC). OBJECTIVE To evaluate whether there is increased prevalence of OASI in VBAC compared with primiparous women. SEARCH STRATEGY Literature search using PubMed, Embase and Cochrane databases. SELECTION CRITERIA All studies with data on both primiparous women and women undergoing VBAC were included. All included studies were evaluated using the "SIGN - methodology checklist" to verify if the quality was acceptable. DATA COLLECTION AND ANALYSIS This systematic review included 23 articles conducted in 11 countries over 19 years. Included studies were analysed using RevMan version 5.4. MAIN RESULTS We found increased prevalence of OASI in the VBAC group; 8.18% (95% confidence interval [CI] 8.07-8.29) compared with 6.59% (95% CI 6.56-6.62) in primiparous women. Correspondingly, the meta-analysis revealed increased prevalence for OASI in the VBAC group (odds ratio 1.27, 95% CI 1.10-1.47). We found a high level of heterogeneity (I2 = 98%). CONCLUSION Women undergoing VBAC had a higher prevalence of OASI compared with primiparous women.
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Affiliation(s)
- Kathrine Perslev
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark
| | - Ella-Josephine Mørch
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Hanna Jangö
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark.,Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Albuquerque RCD, Pereira GMV, Luz AG, Nóbrega MA, Lajos GJ, Brito LGO. Risk factors for mediolateral episiotomy at a tertiary hospital: a cross-sectional study. Rev Assoc Med Bras (1992) 2022; 68:463-469. [DOI: 10.1590/1806-9282.20211251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022] Open
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Desplanches T, Marchand-Martin L, Szczepanski ED, Ruillier M, Cottenet J, Semama D, Simon E, Quantin C, Sagot P. Mediolateral episiotomy and risk of obstetric anal sphincter injuries and adverse neonatal outcomes during operative vaginal delivery in nulliparous women: a propensity-score analysis. BMC Pregnancy Childbirth 2022; 22:48. [PMID: 35045812 PMCID: PMC8772124 DOI: 10.1186/s12884-022-04396-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background The potential protective effect of mediolateral episiotomy for obstetrical anal sphincter injuries (OASIs) remains controversial during operative vaginal delivery because of the difficulties to take into account the risk factors and clinical conditions at delivery; in addition, little is known about the potential benefits of mediolateral episiotomy on neonatal outcomes. The objectives were to investigate the associations between mediolateral episiotomy and both OASIs and neonatal outcomes, using propensity scores. Methods We performed a retrospective population-based observational study from a perinatal registry that includes all births in a French region between 2010 and 2017. All nulliparous women with singleton pregnancy delivering by operative vaginal deliveries at 37 weeks gestational age or later were included. Inverse-probability-of-treatment weighting with propensity scores was used to minimize indication bias. OASIs was defined as third and fourth-degree tears according to Royal College of Obstetricians and Gynecologists. Two neonatal outcomes were studied: condition at birth (5-min Apgar score less than 7 and/or umbilical artery pH less than 7.10), and admission to neonatal intensive care unit. Results The study population consisted of 7589 women; 2880 (38.0%) received mediolateral episiotomy. After applying propensity scores, episiotomy was associated with a lower rate of OASIs in forceps/spatula delivery (2.3 vs 6.8%, Risk Ratio (RR) 0.38, 95% Confidence Interval (CI) 0.28–0.52) and in vacuum delivery (1.3 vs 3.4%, RR 0.27, 95% CI 0.20–0.38) as compared with no episiotomy. Mediolateral episiotomy was associated with better condition at birth in case of forceps/spatula delivery (4.5 vs 8.8%, RR 0.56, 95% CI 0.39–0.81). In cases of fetal distress (40.7%), mediolateral episiotomy was associated with better condition of infant at birth in women who delivered by forceps/spatula (4.2 vs 13.5%, RR 0.52, 95% CI 0.31–0.89). No association was found with neonatal unit admission (RR 0.93, 95% CI 0.50–1.74). Conclusions Use of mediolateral episiotomy was associated with a lower rate of OASIs during operative vaginal delivery, and in infants it was associated with better condition at birth following forceps/spatula delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04396-6.
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Muraca GM, Boutin A, Razaz N, Lisonkova S, John S, Ting JY, Scott H, Kramer MS, Joseph KS. Maternal and neonatal trauma following operative vaginal delivery. CMAJ 2022; 194:E1-E12. [PMID: 35012946 PMCID: PMC8800478 DOI: 10.1503/cmaj.210841] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume. Methods: We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression. Results: Of 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%–25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6–10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%–13.4%) and 9.6 (95% CI 9.0–10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65–1.75) and varied by region, but not by level of obstetric care. Interpretation: In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada.
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Affiliation(s)
- Giulia M Muraca
- Department of Obstetrics and Gynaecology (Muraca, Boutin, Lisonkova, John, Joseph), University of British Columbia, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Muraca, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics (Boutin), Université Laval, Québec City, Quebec; School of Population and Public Health (Lisonkova, Joseph); Division of Neonatology, Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Scott), Dalhousie University and the IWK Health Centre, Halifax, NS; Departments of Epidemiology and Occupation Health and of Pediatrics (Kramer), McGill University, Montréal, Que.
| | - Amélie Boutin
- Department of Obstetrics and Gynaecology (Muraca, Boutin, Lisonkova, John, Joseph), University of British Columbia, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Muraca, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics (Boutin), Université Laval, Québec City, Quebec; School of Population and Public Health (Lisonkova, Joseph); Division of Neonatology, Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Scott), Dalhousie University and the IWK Health Centre, Halifax, NS; Departments of Epidemiology and Occupation Health and of Pediatrics (Kramer), McGill University, Montréal, Que
| | - Neda Razaz
- Department of Obstetrics and Gynaecology (Muraca, Boutin, Lisonkova, John, Joseph), University of British Columbia, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Muraca, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics (Boutin), Université Laval, Québec City, Quebec; School of Population and Public Health (Lisonkova, Joseph); Division of Neonatology, Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Scott), Dalhousie University and the IWK Health Centre, Halifax, NS; Departments of Epidemiology and Occupation Health and of Pediatrics (Kramer), McGill University, Montréal, Que
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology (Muraca, Boutin, Lisonkova, John, Joseph), University of British Columbia, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Muraca, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics (Boutin), Université Laval, Québec City, Quebec; School of Population and Public Health (Lisonkova, Joseph); Division of Neonatology, Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Scott), Dalhousie University and the IWK Health Centre, Halifax, NS; Departments of Epidemiology and Occupation Health and of Pediatrics (Kramer), McGill University, Montréal, Que
| | - Sid John
- Department of Obstetrics and Gynaecology (Muraca, Boutin, Lisonkova, John, Joseph), University of British Columbia, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Muraca, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics (Boutin), Université Laval, Québec City, Quebec; School of Population and Public Health (Lisonkova, Joseph); Division of Neonatology, Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Scott), Dalhousie University and the IWK Health Centre, Halifax, NS; Departments of Epidemiology and Occupation Health and of Pediatrics (Kramer), McGill University, Montréal, Que
| | - Joseph Y Ting
- Department of Obstetrics and Gynaecology (Muraca, Boutin, Lisonkova, John, Joseph), University of British Columbia, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Muraca, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics (Boutin), Université Laval, Québec City, Quebec; School of Population and Public Health (Lisonkova, Joseph); Division of Neonatology, Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Scott), Dalhousie University and the IWK Health Centre, Halifax, NS; Departments of Epidemiology and Occupation Health and of Pediatrics (Kramer), McGill University, Montréal, Que
| | - Heather Scott
- Department of Obstetrics and Gynaecology (Muraca, Boutin, Lisonkova, John, Joseph), University of British Columbia, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Muraca, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics (Boutin), Université Laval, Québec City, Quebec; School of Population and Public Health (Lisonkova, Joseph); Division of Neonatology, Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Scott), Dalhousie University and the IWK Health Centre, Halifax, NS; Departments of Epidemiology and Occupation Health and of Pediatrics (Kramer), McGill University, Montréal, Que
| | - Michael S Kramer
- Department of Obstetrics and Gynaecology (Muraca, Boutin, Lisonkova, John, Joseph), University of British Columbia, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Muraca, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics (Boutin), Université Laval, Québec City, Quebec; School of Population and Public Health (Lisonkova, Joseph); Division of Neonatology, Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Scott), Dalhousie University and the IWK Health Centre, Halifax, NS; Departments of Epidemiology and Occupation Health and of Pediatrics (Kramer), McGill University, Montréal, Que
| | - K S Joseph
- Department of Obstetrics and Gynaecology (Muraca, Boutin, Lisonkova, John, Joseph), University of British Columbia, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Muraca, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics (Boutin), Université Laval, Québec City, Quebec; School of Population and Public Health (Lisonkova, Joseph); Division of Neonatology, Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Scott), Dalhousie University and the IWK Health Centre, Halifax, NS; Departments of Epidemiology and Occupation Health and of Pediatrics (Kramer), McGill University, Montréal, Que
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Laine K, Yli BM, Cole V, Schwarz C, Kwee A, Ayres-de-Campos D, Vayssiere C, Roth E, Gliozheni E, Savochkina Y, Ivanisevic M, Kalis V, Timonen S, Verspyck E, Anstaklis P, Beke A, Eriksen BH, Santo S, Kavsek G, Duvekot H, Dadak C. European guidelines on perinatal care- Peripartum care Episiotomy. J Matern Fetal Neonatal Med 2021; 35:8797-8802. [PMID: 34895000 DOI: 10.1080/14767058.2021.2005022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OF RECOMMENDATIONS1. Episiotomy should be performed by indication only, and not routinely (Moderate quality evidence +++-; Strong recommendation). Accepted indications for episiotomy are to shorten the second stage of labor when there is suspected fetal hypoxia (Low quality evidence ++-; Weak recommendation); to prevent obstetric anal sphincter injury in vaginal operative deliveries, or when obstetric sphincter injury occurred in previous deliveries (Moderate quality evidence +++-; Strong recommendation)2. Mediolateral or lateral episiotomy technique should be used (Moderate quality evidence +++-; Strong recommendation). Labor ward staff should be offered regular training in correct episiotomy techniques (Moderate quality evidence +++-; Strong recommendation).3. Pain relief needs to be considered before episiotomy is performed, and epidural analgesia may be insufficient. The perineal skin needs to be tested for pain before an episiotomy is performed, even when an epidural is in place. Local anesthetics or pudendal block need to be considered as isolated or additional pain relief methods (Low quality evidence ++-; Strong recommendation).4. After childbirth the perineum should be carefully inspected, and the anal sphincter palpated to identify possible injury (Moderate quality evidence +++-; Strong recommendation). Primary suturing immediately after childbirth should be offered and a continuous suturing technique should be used when repairing an uncomplicated episiotomy (High quality evidence ++++; Strong recommendation).
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Affiliation(s)
- Katariina Laine
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway.,Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | | | - Vanessa Cole
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom of Great Britain and Northern Ireland
| | | | | | | | | | | | | | | | | | - Vladimir Kalis
- Czech Society of Perinatology and Feto-Maternal Medicine
| | | | | | | | - Artur Beke
- Hungarian Society of Perinatology and Obstetric Anesthesiology
| | | | - Susana Santo
- Portuguese Society of Obstetrics and Maternal-Fetal Medicine
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Tex-Jack D, Eleke C. Perspectives of skilled birth attendants and pregnant women regarding episiotomy: a quantitative approach. Afr Health Sci 2021; 21:1355-1361. [PMID: 35222601 PMCID: PMC8843249 DOI: 10.4314/ahs.v21i3.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The World Health Organization recommended less than 10% episiotomy rate for Skilled Birth Attendants (SBAs) and hospitals in 1996. More than two decades afterwards, some health facilities are still grappling with meeting the set target. Objectives This study assessed the perspectives of SBAs and pregnant women regarding episiotomy in a Nigerian university teaching hospital. Methods A cross-sectional design was employed. Census sampling was used to select 19 SBAS and 973 vaginal birth records from 2019, while consecutive sampling technique was used to enrol 134 consenting pregnant women obtaining antenatal services in the facility. Data was collected using a three part instrument involving a data extraction sheet, episiotomy practice questionnaire for SBAs, and feelings about episiotomy questionnaire for pregnant women. Assembled data were summarised with descriptive statistics. Results The episiotomy rate was 345(35.5%). About 266 (77.1%) of first time mothers (primips) and 79(22.9%) of nonfirst time mothers (multips) received episiotomy. Ten (52.6%) of the SBAs were unsure of any evidence supporting routine episiotomy. All the 19(100%) SBAs reported that there was no existing facility-based policy regarding routine episiotomy. Seventy five (56%) of the pregnant women reported feeling generally bad about episiotomy. One hundred and one (82.3%) of them hinted that they will not feel satisfied if they were given episiotomy with the reason that it ensures quick vaginal birth. Conclusion The rate of episiotomy was higher than global recommended standards and primips are disproportionately affected. If organised by professional societies, more scientific conferences on limiting episiotomy might remedy this situation.
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Affiliation(s)
- Dokuba Tex-Jack
- University of Port Harcourt, African Centre of Excellence, Centre for Public Health and Toxicological Research
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Gyhagen M, Ellström Engh M, Husslein H, Koelbl H, Nilsson IEK, Schulz J, Wagg A, Milsom I. Temporal trends in obstetric anal sphincter injury from the first vaginal delivery in Austria, Canada, Norway, and Sweden. Acta Obstet Gynecol Scand 2021; 100:1969-1976. [PMID: 34435349 DOI: 10.1111/aogs.14244] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obstetric anal sphincter injuries (OASI) are severe complications that can cause considerable short- and long-term morbidity. Austria, Canada, Norway, and Sweden have similar socio-economic characteristics, and all four countries have access to national birth registers. In this study, we hypothesized that the incidence of OASI should be very similar for different obstetric scenarios in these four countries. Therefore, the aim was to compare the incidence of OASI in these four countries in primiparous women, with spontaneous or instrumental delivery (vacuum or forceps), and in women with a first vaginal birth after cesarean section (VBAC). MATERIAL AND METHODS Aggregated data on 1 933 930 vaginally delivered primiparous women and women with VBAC were retrieved from the birth registers gathered in Austria, Canada, Norway, and Sweden. The annual rate of OASI (ICD-10 codes O70.2-O70.3) was presented as the percentage of women with a spontaneous delivery, vacuum or forceps delivery, and a VBAC during the period 2004-2016. RESULTS The incidence of OASI varied considerably between countries and over time. Canada and Sweden had the highest rates, and Austria and Norway the lowest. In Norway, the rate of OASI decreased consistently for all types of deliveries after introducing a perineal protection program in 2004 (p < 0.001). During vacuum delivery, the incidence of OASI varied between countries from 4.1% to 15.5% across the study period. In Canada and Norway, the rate of OASI after a forceps delivery was similar in 2004 at ~20% and with differing trajectories to 24.3% (β 0.49) and 6.2% (β -1.15) (trend, all p < 0.001) in 2016. CONCLUSIONS This comparative register study suggests that there may be considerable potential for lowering the incidence of OASI. The perineal protection program implemented by Norway has been successful. Each country should critically, without prejudice, analyze their current clinical practices and rate of OASI and consider the best preventive strategy.
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Affiliation(s)
- Maria Gyhagen
- Gothenburg Continence Research Center, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, Borås, Sweden
| | - Marie Ellström Engh
- Department of Obstetrics and Gynecology, Akershus University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Heinrich Husslein
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Heinz Koelbl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Ida E K Nilsson
- Gothenburg Continence Research Center, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, Borås, Sweden
| | - Jane Schulz
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian Wagg
- Gothenburg Continence Research Center, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ian Milsom
- Gothenburg Continence Research Center, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Garcia-Cerde R, Torres-Pereda P, Olvera-Garcia M, Hulme J. Health care workers' perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico. BMC Pregnancy Childbirth 2021; 21:549. [PMID: 34384395 PMCID: PMC8359587 DOI: 10.1186/s12884-021-04022-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how and why this practice persists despite shifts in knowledge and attitudes facilitated by the implementation of an obstetric training program. METHODS This is a descriptive and interpretative qualitative study. We conducted 53 pre and post-intervention (PRONTO© Program) semi-structured interviews with general physician, gynecologists and nurses (N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories. RESULTS Themes fell into five major themes surrounding their perceptions of episiotomy: as a preventive measure, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of health care providers. CONCLUSIONS Perceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this harmful obstetrical practice.
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Affiliation(s)
- Rodrigo Garcia-Cerde
- Departamento de Salud Reproductiva (Department of Reproductive Health), Centro de Investigación en Salud Poblacional (Center for Research in Population Health), Instituto Nacional de Salud Pública de México (National Institute of Public Health of Mexico), Av. Universidad 655, Col. Sta. Maria Ahuacatitlán. Cp, 62100, Cuernavaca, Morelos, Mexico
| | - Pilar Torres-Pereda
- Dirección de Investigación en Equidad para la Salud (Health Equity Research Department), Centro de Investiación en Sistemas de Salud (Center for Health Systems Research), Instituto Nacional de Salud Pública de México (National Institute of Public Health of Mexico), Av. Universidad 655, Col. Sta. Maria Ahuacatitlán. Cp, 62100, Cuernavaca, Morelos, Mexico
| | - Marisela Olvera-Garcia
- Departamento de Salud Reproductiva (Department of Reproductive Health), Centro de Investigación en Salud Poblacional (Center for Research in Population Health), Instituto Nacional de Salud Pública de México (National Institute of Public Health of Mexico), Av. Universidad 655, Col. Sta. Maria Ahuacatitlán. Cp, 62100, Cuernavaca, Morelos, Mexico
| | - Jennifer Hulme
- Department of Family and Community Medicine, University of Toronto, Toronto General Hospital, University Health Network, 200 Elizabeth Street, R. Fraser Elliott Building, Ground Floor, Room 480, Toronto, ON, M5G 2C4, Canada.
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Oliveira SG, Caroci-Becker A, Mendes EDPB, Riesco MLG, Oliveira RDC, Oliveira SMJVD. Pelvic floor dysfunction in primiparous women up to 6 months after delivery: cohort study. Rev Bras Enferm 2021; 74:e20200607. [PMID: 34346955 DOI: 10.1590/0034-7167-2020-0607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/20/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze pelvic floor muscular strength (PFMS), urinary (UI) and anal (AI) incontinence and dyspareunia in primiparous women up to 6 months after normal or cesarean delivery. METHODS this is a prospective cohort with 169 women (128 normal births, 41 cesarean sections), followed between 50-70 and 170-190 days postpartum, when PFMS was measured using perineometry, and UI and AI and dyspareunia, through interview. RESULTS PFMS, UI and dyspareunia were similar between types of delivery. The difference was significant only for the time elapsed, with improvement in the studied period (2 and 6 months postpartum). Regarding AI, there was a significant difference between 2 and 6 months postpartum, with an interaction between type of delivery and time (p=0.022). CONCLUSION the type of delivery did not show any influence on pelvic floor dysfunctions, except for AI. For all outcomes, there was an improvement in the period studied.
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Chill HH, Karavani G, Lipschuetz M, Berenstein T, Atias E, Amsalem H, Shveiky D. Obstetric anal sphincter injury following previous vaginal delivery. Int Urogynecol J 2021; 32:2483-2489. [PMID: 34100977 DOI: 10.1007/s00192-021-04872-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Obstetric anal sphincter injury (OASI) is a debilitating complication of vaginal delivery. The aim of this study was to identify risk factors for OASI in women with a previous vaginal delivery. We further attempted to detect specific risk factors for severe OASI in this subgroup. METHODS We conducted a retrospective cohort study between 2003 and 2019. The study group included women who had a singleton, live, vertex, vaginal delivery at term and who also had at least one previous vaginal delivery. The control group included women with at least one previous vaginal delivery without OASI. General medical history, obstetric history, and ante-, intra- and post-partum data were collected and compared between groups. RESULTS Following implementation of the inclusion criteria, 79,176 women were included. Allocation to study groups was according to OASI occurrence: 135 patients (0.2%) had a third- or fourth-degree perineal tear, while 79,041 patients (99.8%) had no such injury. Multivariate analysis revealed that one previous vaginal delivery, birthweight ≥ 3900 g (90th percentile), vacuum-assisted vaginal delivery and episiotomy were associated with increased risk of OASI. Comparison of more severe OASI (3C and 4th-degree) cases to the control group showed similar results with the addition of prolonged second stage and younger age to risk factors associated with severe OASI while episiotomy was no longer significant. CONCLUSION In women with a previous vaginal delivery, one vs. two or more previous vaginal deliveries, increased birthweight, vacuum-assisted vaginal delivery and episiotomy are risk factors for OASI.
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Affiliation(s)
- Henry H Chill
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, PO Box 12000, Jerusalem, Ein Kerem, Israel.
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Gilad Karavani
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lipschuetz
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | | | - Eyal Atias
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Amsalem
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, PO Box 12000, Jerusalem, Ein Kerem, Israel
- Division of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Yang J, Bai H. Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives: a cross-sectional study from China. BMJ Open 2021; 11:e043596. [PMID: 33846148 PMCID: PMC8047989 DOI: 10.1136/bmjopen-2020-043596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Episiotomy is still performed widely by obstetricians and midwives in some Chinese maternity units, but the reasons are unknown. This study aims to determine the knowledge, attitude and experience towards the practice of episiotomy among obstetricians and midwives in China's public hospitals and consider strategies to reduce its practice. METHODS A cross-sectional web survey using a self-administered questionnaire was conducted among obstetricians and midwives in 90 public hospitals in Henan Province, China. RESULTS 900 (82.21%) participants completed the questionnaire. Average knowledge level (4.15, SD=1.10) on complications and overuse was identified among participants. Episiotomy was performed more frequently in secondary hospitals than in tertiary hospitals (p<0.05). Senior clinicians were more likely to perform episiotomy than younger ones (p<0.05). Almost half of the clinicians (42.11%) considered the current rate of episiotomy (45%) to be right or too low. The most common reason for performing episiotomy identified by obstetricians (83.94%) and midwives (79.69%) was to reduce third-degree or fourth-degree perineal laceration. Both obstetricians (80.29%) and midwives (82.57%) agreed that the most significant obstacle to reducing the rate of episiotomy was lack of training on reducing perineal tears. CONCLUSION In sum, episiotomy was driven by previous training, practitioners' experience and local norms rather than the latest medical evidence. Clinicians in secondary hospitals and senior clinicians are key training targets. It is urgent to improve current clinical policies and surgical procedure guidelines for obstetricians and midwives regarding episiotomy.
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Affiliation(s)
- Jingxuan Yang
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Hua Bai
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
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Dillon SJ, Nelson DB, Spong CY, McIntire DD. Forceps and episiotomy: do they go hand in hand or should they go their separate ways? Am J Obstet Gynecol MFM 2021; 3:100370. [PMID: 33831590 DOI: 10.1016/j.ajogmf.2021.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Shena J Dillon
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9032.
| | - David B Nelson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9032
| | - Catherine Y Spong
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9032
| | - Donald D McIntire
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9032
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Espitia-De La Hoz FJ. Dispareunia en mujeres después de parto vaginal. Prevalencia en dos clínicas de Armenia, Colombia, 2012-2017. DUAZARY 2021. [DOI: 10.21676/2389783x.3887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Se realizó un estudio de corte transversal que tuvo como objetivo determinar la prevalencia de la dispareunia en mujeres con parto vaginal, evaluar posibles factores de riesgo y la asociación con la episiotomía. Ingresaron mujeres atendidas por parto vaginal entre 2012 y 2017 en dos clínicas de alta complejidad en Armenia (Colombia). Se utilizó el cuestionario Índice de Función Sexual Femenina (IFFS-6) para evaluar la función sexual. Los resultados reportan una prevalencia de dispareunia del 59,37%, siendo más prevalente en mujeres sometidas a episiotomía (OR: 68,17; IC95 %: 60,57-79,15). Respecto a la asociación de la episiotomía con la presencia de dispareunia se encontró asociación significativa con la episiotomía medio-lateral (OR: 8,17; IC95%: 2,15-56,32), lesión del esfínter (OR: 7,32; IC95%: 4,86-12,75) y dehiscencia de la sutura (OR: 6,48; IC95%: 4,92-14,28). Se observaron como factores de riesgo: antecedente de endometriosis (OR: 11,6; IC95 %: 9,15-17,52), dolor pélvico crónico (OR: 3,56; IC95%: 2,21–6,32) e ITS (OR: 2,67; IC95%: 1,54–5,14), p=0,003). Se concluye que la prevalencia de dispareunia en mujeres con parto vaginal, atendidas en Armenia, varía en función de la realización de episiotomía, asociándose tanto a las complicaciones de esta como a otros antecedentes.
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Lebraud M, Griffier R, Hmila S, Aubard Y, Gauthier T, Parant O, Guerby P. Comparison of maternal and neonatal outcomes after forceps or spatulas-assisted delivery. Eur J Obstet Gynecol Reprod Biol 2020; 258:126-131. [PMID: 33421809 DOI: 10.1016/j.ejogrb.2020.12.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to compare the perinatal outcomes associated with spatulas or forceps assisted delivery. STUDY DESIGN This is a bicentric retrospective cohort study including all assisted deliveries in cephalic presentation after 37 weeks of gestation, performed on singleton pregnancy with forceps and with spatulas in two tertiary centers. The main outcome was the rate of episiotomy. Secondary outcomes included obstetric anal sphincter injuries (OASIS), maternal outcomes and neonatal parameters. RESULTS Out of 37 002 deliveries, the overall rate of assisted delivery was 11.4 %, and 1 041 (2.8 %) assisted deliveries with forceps and 2 462 (6.7 %) spatulas deliveries were included. The rate of episiotomy was 90.3 % after forceps-assisted delivery and 70.9 % for spatulas (p < 0.001). The rate of OASIS was 7.2 % and 5.6 % respectively (p = 0.06). A slight but significant decrease in neonatal trauma after spatulas was observed. CONCLUSION In this retrospective cohort study, the episiotomy rate was higher with forceps assisted deliveries than with spatulas. Both instruments have low neonatal morbidity and are similar regarding OASIS.
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Affiliation(s)
- Margaux Lebraud
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France
| | - Romain Griffier
- Department of Public Health, CHU Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France
| | - Salwa Hmila
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Yves Aubard
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Tristan Gauthier
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France; Université Paul-Sabatier Toulouse III, 31330 Toulouse, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France; Université Paul-Sabatier Toulouse III, 31330 Toulouse, France.
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Ekstein-Badichi N, Shoham-Vardi I, Weintraub AY. Temporal trends in the incidence of and associations between the risk factors for obstetrical anal sphincter injuries. Am J Obstet Gynecol MFM 2020; 3:100247. [PMID: 33451614 DOI: 10.1016/j.ajogmf.2020.100247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/26/2020] [Indexed: 12/18/2022]
Abstract
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 (1988-1997, 1998-2007, 2008-2016, 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) temporal trends in the incidence and odds ratio of some of the known risk factors for obstetrical anal sphincter injuries. A better understanding of the changes in the incidence and specific contribution of important risk factors for obstetrical anal sphincter injuries may explain, in part, the worldwide increase in the prevalence of this important and detrimental complication of vaginal birth.
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Affiliation(s)
- Naava Ekstein-Badichi
- Department of Public Health, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er Sheva, Israel.
| | - Ilana Shoham-Vardi
- Department of Public Health, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Adi Y Weintraub
- Department of Public Health, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er Sheva, Israel; Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er Sheva, Israel
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Risk factors for obstetric anal sphincter injury among parous women. Arch Gynecol Obstet 2020; 303:709-714. [PMID: 32975606 DOI: 10.1007/s00404-020-05806-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Nulliparity and operative vaginal delivery are established risk factor for obstetric anal sphincter injury (OASI). However, risk factors for OASIS occurrence among parous women delivering vaginally are not well-established. We aimed to study the risk factors for OASI occurrence among parous women. METHODS A retrospective study including all parous women who delivered vaginally at term during 2011-2019 at a university hospital. Deliveries of parous women with OASI were compared to deliveries without OASI. The risk factors associated with OASI were investigated. RESULTS Overall, 35,397 women were included in the study with an OASI rate of 0.4% (n = 144). A higher rate of only one previous vaginal delivery was noted in the OASI group (78.5% vs. 46.4%, OR [95% CI] 4.20, 2.82-6.25, p < 0.001). The rate of vacuum-assisted deliveries was comparable between the study groups. The median birth weight was higher among the OASI group (3566 vs. 3300 g, p < 0.001), as was the rate of macrosomic neonates (19.4% vs. 5.5%, OR [95% CI] 4.15, 2.74-6.29, p < 0.001). On multivariate logistic regression analysis, only two factors were independently positively associated with the occurrence of OASI: a history of only one previous vaginal delivery (adjusted OR [95% CI] 4.34, 2.90-6.49, p = 0.001), and neonatal birth-weight (for each 500 g increment) (adjusted OR [95% CI] 2.51, 1.84-3.44, p < 0.001). CONCLUSIONS Among parous women, the only factors found to be independently positively associated with OASI were the order of parity and neonatal birth-weight. Vacuum-assisted delivery was not associated with an increased risk of OASI among parous women.
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von Theobald P, Bohrer M, Lorrain S, Iacobelli S. Risk factors associated with severe perineal tears: A five-year study. J Gynecol Obstet Hum Reprod 2020; 49:101820. [PMID: 32450305 DOI: 10.1016/j.jogoh.2020.101820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Our aim was to describe risk factors associated with 34DPT in operative and non-operative vaginal deliveries, over a five-year period. STUDY DESIGN This was a retrospective cohort study including 39,227 vaginal deliveries from 2013 to 2017 in a single French University Hospital. Annual characteristics of the analyzed population were recorded. Univariate logistic regression was used to evaluate the association between these characteristics and 34DPT. Multivariate analysis was used to identify combinations of risk factors associated with instrumental delivery. RESULTS The rate of perineal tears was constantly rising but rate of 34DPT was stable, ranging between 0.8 and 1.4% over the study period. Cesarean section rate was stable between 18.8% and 19.6%. Rate of diabetes, preeclampsia and obesity (BMI < 40) was increasing and episiotomy rate decreasing (from 19.8% to 11.8%). Operative deliveries rate remained stable between 11 and 12.8%. Multivariate regression showed that gestational age over 39 weeks (aOR 1.18, 95% CI [1.02; 1.35]), birth weight over 3500 g (aOR 1.62, 95% CI [1.05; 2.49]) were associated with 34DPT in patients without operative vaginal deliveries but not episiotomy. Gestational age (aOR 1.71, 95% CI [1.18; 2.47]), episiotomy (aOR 0.55, 95% CI [0.38; 0.79]) and diabetes (aOR 1.73, 95% CI [1.15; 2.61]) were associated with 34DPT among patients with operative vaginal deliveries. CONCLUSION In a tertiary medical center model with low cesarean section rate, factors associated with 34DPT were different among patients with or without operative vaginal delivery. The question of the protective effect of mediolateral episiotomy against 34DPT in case of operative delivery deserves further investigations.
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Affiliation(s)
- P von Theobald
- Centre d'Études Périnatales de l'Océan Indien (CEPOI) - EA7388, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre Cedex, La Réunion, France; Service de Gynécologie et Obstétrique, CHU de la Réunion, Hôpital Félix Guyon, Allée des Topazes, CS 11021, 97405 Saint Denis de La Réunion Cedex, France.
| | - M Bohrer
- Département d'Informatique Médicale, CHU de la Réunion, Hôpital Félix Guyon, Allée des Topazes, CS 11021, 97405 Saint Denis de La Réunion Cedex, France
| | - S Lorrain
- Centre d'Études Périnatales de l'Océan Indien (CEPOI) - EA7388, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre Cedex, La Réunion, France
| | - S Iacobelli
- Centre d'Études Périnatales de l'Océan Indien (CEPOI) - EA7388, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre Cedex, La Réunion, France; Réanimation Néonatale et Pédiatrique, Néonatologie, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre Cedex, La Réunion, France
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Author Response: No. 381-Assisted Vaginal Birth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:407-408.e1. [PMID: 32303294 DOI: 10.1016/j.jogc.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Transanale (3D‑)Ultraschalldiagnostik von Sphinkterdefekten und rektovaginalen Fisteln. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00450-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Muraca GM, Joseph KS. The authors respond to "Routine use of episiotomy with forceps should not be encouraged". CMAJ 2020; 192:E191-E192. [PMID: 32094271 PMCID: PMC7043826 DOI: 10.1503/cmaj.74565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Giulia M Muraca
- Postdoctoral fellow, Clinical Epidemiology Unit, Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden, and Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - K S Joseph
- Professor, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
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Klein MC, Kaczorowski J. Routine use of episiotomy with forceps should not be encouraged. CMAJ 2020; 192:E190. [PMID: 32094270 DOI: 10.1503/cmaj.74132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michael C Klein
- Emeritus professor of family practice, University of British Columbia, Vancouver, BC
| | - Janusz Kaczorowski
- Professor of family and emergency medicine, Université de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Que
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Levin G, Rottenstreich A, Cahan T, Ilan H, Shai D, Tsur A, Meyer R. Does birthweight have a role in the effect of episiotomy on anal sphincter injury? Arch Gynecol Obstet 2020; 301:171-177. [DOI: 10.1007/s00404-020-05444-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/13/2020] [Indexed: 01/21/2023]
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