Abstract
Purpose
There is relatively little information on episiotomies in the context of restricted episiotomy use. This study sought to examine maternal and neonatal injuries with restricted episiotomy use.
Methods
We performed a retrospective database analysis of vaginal deliveries at a tertiary care maternity hospital from June 2010 to June 2015. Maternal injuries (third- or fourth-degree lacerations) and neonatal injuries (birth trauma) were identified through the International Classification of Diseases, Ninth Revision, codes. Vaginal deliveries were classified as spontaneous, vacuum-assisted, or forceps-assisted. The associations between episiotomy and maternal and neonatal injuries were examined with stratification by parity, type of vaginal delivery, and type of episiotomy (midline or mediolateral). Adjusted-odds’ ratios were calculated for maternal and neonatal injuries using a multiple logistic regression model to adjust for potential confounders.
Results
22,800 deliveries occurred during the study interval involving 23,016 neonates. The episiotomy rate was 6.7 % overall and 22.9 % in operative vaginal deliveries. Episiotomies, both midline and mediolateral, were associated with increased risks of maternal and neonatal injuries regardless of parity (p < 0.0001). Upon stratification by the type of delivery, the association with maternal injury remained only for spontaneous vaginal deliveries (p < 0.0001). Adjusted-odds’ ratios demonstrated a continued association between episiotomy and maternal [aOR 1.67 (1.39–2.05)] and neonatal injuries [aOR 1.43 (1.17–1.73)].
Conclusion
Episiotomy continues to be associated with increased third- and fourth-degree lacerations with restricted use, particularly in spontaneous vaginal deliveries.
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No funding source was utilized for this study.
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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. For this type of study, formal consent is not required. This study received IRB exemption from the Hawaii Pacific Health Research Institute.
Appendix: International Classification of Diseases-9 (ICD-9) codes used to identify maternal and neonatal injuries
Appendix: International Classification of Diseases-9 (ICD-9) codes used to identify maternal and neonatal injuries
ICD-9 | Code description | Corresponding ICD-10 |
|---|---|---|
Maternal injury | ||
664.20 | Third-degree perineal laceration unspecified as to episode of care in pregnancy | O70.2 |
664.21 | Third-degree perineal laceration with delivery | O70.2 |
664.30 | Fourth-degree perineal laceration unspecified as to episode of care in pregnancy | O70.3 |
664.31 | Fourth-degree perineal laceration with delivery | O70.3 |
Neonatal injury | ||
767.0 | Subdural and cerebral hemorrhage, birth trauma | P10.0; P10.1; P10.4 |
767.11 | Epicranial subaponeurotic hemorrhage | P12.2 |
767.19 | Other birth injuries to scalp | P12.0; P12.89 |
767.2 | Fracture of clavicle, birth trauma | P13.4 |
767.3 | Other injuries to skeleton, birth trauma | P13.0; P13.2; P13.3; P13.8 |
767.5 | Facial nerve injury, birth trauma | P11.3 |
767.6 | Injury to brachial plexus, birth trauma | P14.0; P14.1; P14.3 |
767.7 | Other cranial and peripheral nerve injuries, birth trauma | P11.4; P14.2; P14.8 |
767.8 | Other specified birth trauma | P15.0; P15.1; P15.2; P15.3; P15.5; P15.8 |
767.9 | Birth trauma, unspecified | P15.9 |
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Yamasato, K., Kimata, C., Huegel, B. et al. Restricted episiotomy use and maternal and neonatal injuries: a retrospective cohort study. Arch Gynecol Obstet 294, 1189–1194 (2016). https://doi.org/10.1007/s00404-016-4154-2
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DOI: https://doi.org/10.1007/s00404-016-4154-2