Episiotomy: Are Indian Obstetricians Getting the Angle Right?

Background: A mediolateral episiotomy is recommended when indicated at a 60° angle at crowning, to avoid obstetric anal sphincter injuries (OASIs) by episiotomies angled too close or distant to the anus. This study surveyed obstetricians in India regarding the recommended episiotomy angle and their ability to correctly draw the angle.

Methods: Workshops were conducted in India to share knowledge in the prevention and repair of OASIs.

The prevention of perineal trauma during vaginal birth.

Perineal trauma after vaginal birth is common, with approximately 9 of 10 women being affected. Second-degree perineal tears are twice as likely to occur in primiparous births, with a incidence of 40%. The incidence of obstetrical anal sphincter injury is approximately 3%, with a significantly higher rate in primiparous than in multiparous women (6% vs 2%).

Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study.

Introduction: Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three-dimensional endoanal ultrasound (3D-EAUS).

The incidence of anal incontinence following obstetric anal sphincter injury graded using the Sultan classification: a network meta-analysis.

Objective: This study aimed to systematically determine and compare the incidence of anal incontinence between those with different grades of obstetric anal sphincter injury.

Data Sources: Ovid MEDLINE, Embase, and the Cochrane Library were searched from January 2000 to April 2021.

Study Eligibility Criteria: Observational studies investigating the incidence of anal incontinence following an obstetric anal sphincter injury that was graded using the Sultan classification were eligible for inclusion.

Bacterial autofluorescence in infected perineal wounds: A prospective cohort study.

Diagnosis of perineal wound infection based solely on clinical signs and symptoms is subjective, and often incorrectly identifies wounds with clinically significant bacterial loads. New advances in wound care such as bacterial fluorescence imaging allow point-of -care assessment of bacterial burden. This single-center, prospective observational study included 80 women with perineal wound infection and aimed to determine the incidence of significant bacterial colonization identified with bacterial fluorescence imaging.

The clinical progression and wound healing rate of dehisced perineal tears healing by secondary intention: A prospective observational study.

Objectives: To establish the clinical progression of dehisced perineal wounds healing by secondary intention and to investigate the incidence and factors associated with delayed healing.

Methods: Secondary analysis of women with perineal wound dehiscence recruited into the PERINEAL study between August 2020- August 2021 (NCT04480684). Three-dimensional wound measurements were taken with the Silhouette® camera.

The incidence of wound complications following primary repair of obstetric anal sphincter injury: a systematic review and meta-analysis.

Objective: We aimed to systematically determine the incidences of wound infection and dehiscence after primary obstetric anal sphincter injury repair.

Data Sources: MEDLINE, Embase, CINAHL, EmCare, the Cochrane Library, and Trip Pro databases were searched from inception to February 2021.

Study Eligibility Criteria: We included observational clinical studies reporting the incidences of wound infection and dehiscence after primary obstetric anal sphincter injury repair.

Mediolateral/lateral episiotomy with operative vaginal delivery and the risk reduction of obstetric anal sphincter injury (OASI): A systematic review and meta-analysis.

Introduction And Hypothesis: OASI complicates approximately 6% of vaginal deliveries. This risk is increased with operative vaginal deliveries (OVDs), particularly forceps. However, there is conflicting evidence supporting the use of mediolateral/lateral episiotomy (MLE/LE) with OVD.

Healing of disrupted perineal wounds after vaginal delivery: a poorly understood condition.

Perineal injury following childbirth can result in complications such as wound infection and dehiscence. The reported incidence of these complications in the literature range between 0.1-23.

Early secondary repair of obstetric anal sphincter injuries (OASIs): experience and a review of the literature.

Introduction And Hypothesis: Secondary anal sphincter repair for a dehisced obstetric anal sphincter injury (OASI) is required following 2.6% of primary repairs. There is growing evidence that instead of delaying repair for 3-6 months, early secondary repair of the anal sphincter can be completed within 14 days.

Effect of a subsequent pregnancy on anal sphincter integrity and function after obstetric anal sphincter injury (OASI).

Introduction And Hypothesis: Endoanal ultrasound (EAUS) and anal manometry are used in the assessment women with a history of obstetric anal sphincter injury (OASI), both postpartum and in a subsequent pregnancy, to aid counselling regarding mode of delivery (MOD).

Methods: A prospective observational study between 2012 to 2020 was completed. Women were reviewed 3 months postpartum following OASI and in the second half of a subsequent pregnancy.

Outcome of anal symptoms and anorectal function following two obstetric anal sphincter injuries (OASIS)-a nested case-controlled study.

Introduction And Hypothesis: Obstetric anal sphincter injury (OASI) is a significant risk factor for developing anal incontinence. It can therefore be hypothesised that recurrent OASI in a subsequent delivery may predispose women to further anal sphincter dysfunction.

Methods: A nested case-controlled study based on data collected prospectively between 2006 and 2019.