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The role of fetal head circumference in the formation of obstetric anal sphincter injuries following vacuum deliveries among primiparous women

  • Maternal-Fetal Medicine
  • Published:
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Abstract

Purpose

To evaluate the association of sonographic fetal head circumference (HC) with obstetric anal sphincter injury (OASIS) occurrence among primiparous women who underwent vacuum-assisted delivery (VAD).

Methods

A retrospective study of all primiparous women who delivered at term by VAD between 2011 and 2019 and underwent ultrasound with fetal biometry within 1 week prior to delivery. Women who suffered OASIS were compared to women without OASIS.

Results

Overall, 74 of 3222 (2.3%) primiparous women suffered an OASIS. As compared with control, women with OASIS were younger (median 28 vs. 30 years, p = 0.001), had higher BMI (median 28.2 vs. 26.9 kg/m2, p = 0.03), and had a longer second stage of labor (median 190 vs. 168 min, p = 0.01). Fetal head circumference was larger in the OASIS group (mean 334 vs. 330 mm, p = 0.03), occiput posterior fetal head position was more prevalent (12 (16%) vs. 232 (7.4%), OR [95% CI]: 2.43 (1.29–4.57), p = 0.004), and the rate of mediolateral episiotomy performed was lower (58 (78.0%) vs. 2777 (88.2%), OR [95% CI]: 0.48 (0.27–0.85), p = 0.01). Multivariate regression modeling identified higher fetal HC (aOR [95% CI] 1.03 (1.001–1.06), p = 0.04) and occiput posterior (aOR [95% CI] 2.5 (1.16–5.71), p = 0.01) as independently positively associated with OASIS. Mediolateral episiotomy and maternal age were independently negatively associated with an OASIS (aOR [95% CI] 0.39 (0.18–0.85), p = 0.01); aOR [95% CI] 0.4 (0.17–0.60), p = 0.001).

Conclusions

Sonographic large fetal HC is associated with OASIS occurrence during VAD. The only modifiable predictor of OASIS detected was mediolateral episiotomy, found to be protective against OASIS.

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Abbreviations

OASIS:

Obstetric anal sphincter injury

VAD:

Vacuum-assisted delivery

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Funding

No external funding was used in this conduct of this study.

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Author notes

  1. Raanan Meyer and Amihai Rottenstreich contributed equally to this work.

Authors and Affiliations

  1. The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel

    Raanan Meyer, Moran Shapira, Menachem Alcalay & Yoav Yinon

  2. The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel

    Amihai Rottenstreich & Gabriel Levin

  3. The Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat-Gan, Israel

    Edward Ram

Authors
  1. Raanan Meyer
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  2. Amihai Rottenstreich
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  7. Gabriel Levin
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Contributions

All authors contributed to the manuscript. GL, RM and AR reviewed the literature and wrote the paper. MS, MA, ER and YY performed the procedures and collected the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gabriel Levin.

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Authors declare that they have no conflict of interest.

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For this type of study, formal consent is not required and was waived by the institutional review board approval. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Meyer, R., Rottenstreich, A., Shapira, M. et al. The role of fetal head circumference in the formation of obstetric anal sphincter injuries following vacuum deliveries among primiparous women. Arch Gynecol Obstet 301, 1423–1429 (2020). https://doi.org/10.1007/s00404-020-05558-7

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  • DOI: https://doi.org/10.1007/s00404-020-05558-7

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