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The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of a national registry

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Abstract

Introduction and hypothesis

Obstetric anal sphincter injuries (OASIS) are associated with an increased risk of faecal incontinence after vaginal delivery. The aim of this retrospective population-based cohort study was to assess whether mediolateral episiotomy is associated with a reduction in the rate of OASIS during operative vaginal delivery.

Methods

We used data from the Dutch Perinatal Registry (Perined) that includes records of almost all births between 2000 and 2010 in The Netherlands. In a cohort of 170,969 primiparous and multiparous women whose delivery was recorded, we estimated the association between mediolateral episiotomy and OASIS following both vacuum and forceps deliveries using univariate and multivariate logistic regression analysis.

Results

The incidences of OASIS following vacuum delivery in 130,157 primiparous women were 2.5% and 14% in those with and without a mediolateral episiotomy, respectively (adjusted OR 0.14, 95% CI 0.13–0.15), and in 29,183 multiparous women were 2.0% and 7.5%, respectively (adjusted OR 0.23, 95% CI 0.21–0.27). The incidences of OASIS following forceps delivery in 9,855 primiparous women were 3.4% and 26.7% in those with and without a mediolateral episiotomy, respectively (adjusted OR 0.09, 95% CI 0.07–0.11), and in 1,774 multiparous women were 2.6% and 14.2%, respectively (adjusted OR 0.13, 95% CI 0.08–0.22).

Conclusions

The use of a mediolateral episiotomy during both vacuum delivery and forceps delivery is associated with a fivefold to tenfold reduction in the rate of OASIS in primiparous and multiparous women.

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Acknowledgments

We thank all Dutch midwives, obstetricians, neonatologists, and other perinatal health-care providers for the registration of perinatal information and Perined (www.perined.nl) for permission to use the registry data.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Amphia Hospital Breda, Langendijk 75, 4819 EV, Breda, The Netherlands

    Jeroen van Bavel & Dimitri N. M. Papatsonis

  2. The Netherlands Perinatal Registry, Utrecht, The Netherlands

    Chantal W. P. M. Hukkelhoven & Charlotte de Vries

  3. Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands

    Joey de Vogel

  4. Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands

    Jan-Paul W. R. Roovers

  5. The Robinson Research Institute, School of Medicine, University of Adelaide, South Australian Health and Medical Research Institute Adelaide, Adelaide, Australia

    Ben Willem Mol

  6. Department of Obstetrics and Gynecology, Ikazia Hospital, Rotterdam, The Netherlands

    Jan Willem de Leeuw

Authors
  1. Jeroen van Bavel
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  2. Chantal W. P. M. Hukkelhoven
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  3. Charlotte de Vries
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  4. Dimitri N. M. Papatsonis
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  5. Joey de Vogel
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  6. Jan-Paul W. R. Roovers
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  7. Ben Willem Mol
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  8. Jan Willem de Leeuw
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Corresponding author

Correspondence to Jeroen van Bavel.

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Ethical approval

No ethical approval was needed as the analyses were based on anonymous registry data.

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van Bavel, J., Hukkelhoven, C.W.P.M., de Vries, C. et al. The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of a national registry. Int Urogynecol J 29, 407–413 (2018). https://doi.org/10.1007/s00192-017-3422-4

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  • DOI: https://doi.org/10.1007/s00192-017-3422-4

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