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Trigonometric characteristics of episiotomy and risks for obstetric anal sphincter injuries in operative vaginal delivery

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Abstract

Introduction and hypothesis

The objective of this study was to investigate the association between the trigonometric properties of episiotomy in operative vaginal delivery (OVD) and obstetric anal sphincter injuries (OASIS).

Methods

The study included 72 primiparous women who had an OVD and episiotomy. Cases (n = 36) had sustained OASIS at birth, while controls (n = 36) had not. The groups were matched for instrumental delivery. The episiotomy scar was identified and its trigonometric characteristics were measured at 8–12 weeks postpartum. Data were analysed using conditional logistic analysis.

Results

The angle of episiotomy behaves as a factor associated with anal sphincter injury, so women with a mediolateral episiotomy and an angle greater than 20° have an 87 % less risk of having an OASIS (odds ratio 0.13, 95 % confidence interval 0.03–0.58). The study showed that scarred episiotomies at 8–12 weeks after OVD with an angle ≤ 20°, depth and distance between the episiotomy and anus ≤ 15 mm, total upper triangle perimeter ≤ 75 mm, para-anal triangle perimeter ≤ 15 mm and areas between scar and midline ≤ 250 mm2 were significantly associated with higher risk of OASIS.

Conclusions

When a mediolateral episiotomy is performed in OVD the technique has a strong effect on the occurrence of OASIS. Additional research is needed to determine if the optimal technique for mediolateral episiotomies produces less OASIS than deferring the performance of episiotomy.

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Authors and Affiliations

  1. Pelvic Floor Unit, Department of Obstetrics and Gynaecology, Complejo Asistencial Universitario of León (CAULE), C/ Altos de Nava S/N, 24080, León, Spain

    E. Gonzalez-Díaz & A. Fernández Corona

  2. Department of Preventive Medicine, Hospital Clínico Universitario of Valladolid (HCUV), Valladolid, Spain

    L. Moreno Cea

Authors
  1. E. Gonzalez-Díaz
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  2. L. Moreno Cea
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  3. A. Fernández Corona
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Correspondence to E. Gonzalez-Díaz.

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Gonzalez-Díaz, E., Moreno Cea, L. & Fernández Corona, A. Trigonometric characteristics of episiotomy and risks for obstetric anal sphincter injuries in operative vaginal delivery. Int Urogynecol J 26, 235–242 (2015). https://doi.org/10.1007/s00192-014-2491-x

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  • DOI: https://doi.org/10.1007/s00192-014-2491-x

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