Background: We are lacking data with a high level of evidence on the use of episiotomy during instrumental delivery to prevent anal sphincter injury, which nonetheless presents the highest risk.
Objective: Our main objective was to assess the protective effect of episiotomy against obstetric anal sphincter injury in nulliparous women during instrumental delivery according to type of instrument. We also investigated its impact on immediate maternal and neonatal morbidity.
Study Design: We conducted a prospective comparative cohort study for clinical trial emulation by means of propensity score weighting. The study was especially designed for consideration of possible confounders. This was a nationwide observational multicenter study including 111 French public and private maternity units between April 2021 and March 2022. We included nulliparous women, with singleton cephalic fetus, at more than 34 weeks of gestation. We considered vacuum, forceps, and spatula deliveries. We proceeded to a comparative analysis between women with and without episiotomy. The main outcome was obstetric anal sphincter injury occurrence. We used composite criteria for both maternal and neonatal immediate morbidity.
Results: The analyses pertained to 11,013 women. Overall prevalence of episiotomy was 23%: 17% for vacuum (N=7007), 37% for forceps (N=2378), and 29% in case of spatula-assisted (N=1628) delivery. Episiotomy was not associated with significantly decreased obstetric anal sphincter injury occurrence in vacuum delivery (from 5.2% without episiotomy to 3.8%, odds ratio=0.73 [0.48-1.03]) or forceps delivery (from 10.9% without episiotomy to 8.8%, odds ratio=0.81 [0.56-1.14]). In contrast, we observed significantly decreased obstetric anal sphincter injury occurrence (from 9.4% without episiotomy to 5.6%) in spatula delivery (odds ratio=0.60 [0.37-0.87]). Episiotomy was associated with increased maternal morbidity using forceps (from 13.6%-18.3%, odds ratio=1.35 [1.01-1.73]) and spatulas (from 9.0%-13.4%, odds ratio=1.51 [1.11-2.00]). We also observed increased neonatal morbidity in vacuum delivery associated with episiotomy (from 9.1%-13.6%, odds ratio=1.49 [1.21-1.79]), but a decrease in case of forceps delivery with episiotomy (from 12.6%-9.2%, odds ratio=0.74 [0.55-0.95]).
Conclusion: Episiotomy was not associated with a decreased risk of obstetric anal sphincter injury in vacuum or forceps delivery, and a marginal reduction was achieved using spatulas. Our results do not favor extensive episiotomy during instrumental delivery.
Trial Registration: ClinicalTrial NCT 04446780.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.ajog.2025.01.029 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Superselective superior rectal artery embolization in the treatment of hemorrhoidal disease.
Front Med (Lausanne)
February 2025
Department of Proctology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China.
Hemorrhoids are a prevalent and benign anal disorder for which minimally invasive treatments are increasingly preferred. The UK National Institute for Health and Care Excellence clinical guideline (2010) recommends hemorrhoidal artery ligation as a treatment option for hemorrhoidal disease. Superior rectal artery embolization (SRAE) leverages this principle by using digital subtraction angiography to precisely identify and superselectively embolize the arteries supplying the hemorrhoidal region.
View Article and Find Full Text PDFMucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study.
Int J Colorectal Dis
March 2025
Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Purpose: There is no consensus on the standard approach for trans-sphincteric perianal fistulas (TPAF) in the elderly population. The most commonly used sphincter-saving procedures are ligation of the inter-sphincteric fistula tract (LIFT) and mucosal advancement flap (MAF). We aimed to evaluate the incidence and risk factors for recurrence and incontinence in elderly patients with TPAF using both approaches.
View Article and Find Full Text PDFStandardised Functional Assessment in Females With Low Anorectal Malformation to Determine Need for Surgery.
J Pediatr Surg
February 2025
Department of Paediatric Surgery, Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital WC1N3JH London, UK.
Background: The indications for surgical treatment in females with anterior anus remain controversial. We analysed the clinical outcomes in two groups: those who underwent surgery and those who received conservative treatment. We propose a standardized assessment, focusing on functional aspects, to determine the necessity of surgical intervention.
View Article and Find Full Text PDFAre women adequately informed about the use of instrumentation during vaginal delivery? A prospective review of the information on instrumental delivery provided to pregnant women and a retrospective review of the quality of consent for instrumental delivery.
Colorectal Dis
March 2025
Sir Alan Parks Department of Physiology, St Mark's Hospital, National Bowel Hospital, London, UK.
Aim: Instrumental delivery typically describes the use of ventouse or forceps to aid vaginal delivery. They are used in 10%-15% of all vaginal deliveries and in almost a third of all primiparous deliveries. They are associated with an increased risk of maternal and neonatal injury.
View Article and Find Full Text PDFComment on "Gestational Diabetes Mellitus Affects the Risk of Obstetric Anal Sphincter Injury: A Systematic Review and Meta-Analysis of Cohort Studies".
Int Urogynecol J
March 2025
Center for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, India.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!