Objective: to examine potential association between mediolateral episiotomy and reduced incidence of obstetrical anal sphincter injuries (OASIS) diagnosed by endoanal ultrasound.
Design: prospective cohort study.
Setting: tertiary referral university hospital.
Participants: sixty nulliparous women at 28-33 weeks of gestation with singleton pregnancies were included between 2010 and 2012.
Measurements And Findings: participants were examined with endoanal ultrasound at 28-33 weeks gestation and at 6-7 weeks post-partum. At both visits, symptoms of anal incontinence were assessed using Cleveland Clinic (Wexner) faecal incontinence scoring system. Mann Whitney U-test and χ test was used to compare groups with vs. without episiotomy and groups with vs. without OASIS diagnosed by ultrasound. χ test was used to assess correlation between OASIS and anal incontinence symptoms (p≤0.05 considered significant). None of the women included had sphincter injury or anal incontinence before childbirth. All delivered vaginally. Mediolateral episiotomy was performed in 33 (55%) cases. Six (10%) had OASIS on endoanal ultrasound (two were also diagnosed clinically), and 11 had symptoms of anal incontinence post-partum. No significant differences were seen in clinical characteristics between groups with vs. without episiotomy. No significant differences were seen in episiotomy rate (p=0.14), angle (p=0.42) and length (p=0.14) between groups with vs. without OASIS on ultrasound. Correlation between anal incontinence symptoms and sonographically diagnosed OASIS was statistically significant (p=0.04).
Key Conclusions: mediolateral episiotomy does not seem to be protective against clinically or sonographically diagnosed OASIS even when episiotomy technique is considered. Endoanal ultrasound allows a significantly better detection of symptomatic OASIS compared to clinical examination alone.
Implications For Practice: mediolateral episiotomy should be considered only when shortening the second stage of labour is indicated due to foetal distress, and not as a means of OASIS prevention.
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Article Synopsis
- The study examines the relationship between mediolateral episiotomy and obstetric anal sphincter injuries (OASIS) in young women post-childbirth, aiming to clarify existing uncertainties.
- Conducted at a tertiary medical center with data from 18,202 vaginal and vacuum-assisted deliveries from 2015 to 2021, the study observed a decline in episiotomy rates and an increase in OASIS during the latter period.
- The results indicate that while episiotomy use has decreased, there’s no significant association between episiotomy and OASIS; instead, the use of epidural analgesia showed a protective benefit against OASIS.
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