Mediolateral episiotomy significantly reduces the risk of obstetric-associated anal sphincter injury (OASIS) in women who deliver via vacuum extraction

2014 ◽  
Vol 19 (4) ◽  
pp. 155-155 ◽  
Author(s):  
Adil E Bharucha ◽  
David Prichard
Keyword(s):  
Anal Sphincter ◽  
Vacuum Extraction ◽  
Sphincter Injury ◽  
Mediolateral Episiotomy ◽  
Anal Sphincter Injury

scholarly journals Third and Fourth Degree Perineal Tear in Four-Year Period at Sestre Milosrdnice University Hospital Center, Zagreb, Croatia

2018 ◽  
Vol 6 (6) ◽  
pp. 1067-1071 ◽  
Author(s):  
Ivka Djaković ◽  
Emina Ejubović ◽  
Ivan Bolanča ◽  
Marina Markuš Sandrić ◽  
Dino Bečić ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Gestational Age ◽  
Obstetric Anal Sphincter Injury ◽  
Large For Gestational Age ◽  
Vacuum Extraction ◽  
Sphincter Injury ◽  
Fourth Degree ◽  
Anal Sphincter Injury ◽  
Perineal Injury ◽  
Vaginal Deliveries

OBJECTIVES: Obstetric anal sphincter injury (OASIS) includes the third and fourth degree of perineal injury. The risk for OASIS is about 1% of all vaginal deliveries. If not recognised and treated properly, obstetric anal sphincter injury can have serious consequences for reproductive age woman.MATERIAL AND METHODS: We have retrospectively gathered and analysed data on obstetric anal sphincter injury in a four-year period at our department. The control group in this study included vaginal deliveries in 2012.RESULTS: We recorded 0.34% third and fourth degree of perineal injury in all vaginal deliveries, and 87.9% of those patients were primiparae. Episiotomy was performed in 57.6% of all women with obstetric anal sphincter injury. In 30.3% of cases, newborns were large for gestational age. Gestational diabetes was found in 9.1% of OASIS cases, occipitoposterior position was found in 9.1% of cases. Induced labour took place in 39.4%, and oxytocin infusion was applied in 60.6% of OASIS cases. Vacuum extraction was performed in 12.1% of deliveries with OASIS. The average BMI in 3a and 3b injuries was 29.9. In 3c degree it was 28.0, and in the fourth degree, it was 32.1. In 27.0% of OASIS cases due to the extent of the injury surgeon engagement was necessary. When compared with vaginal deliveries in 2012 we found a significant increase in OASIS in primiparas, large for gestational age, occipitoposterior position, induced labour, vacuum extraction and hypertension (P < 0.01). There is also increased incidence of OASIS in episiotomy and oxytocin use group (P < 0.05).CONCLUSION: Low incidence of OASIS in our department is a result of active management of delivery, manual perineal protection and timely episiotomy.

Impact of mediolateral episiotomy on incidence of obstetrical anal sphincter injury diagnosed by endoanal ultrasound

Midwifery ◽  
2017 ◽  
Vol 51 ◽  
pp. 40-43 ◽  
Author(s):  
Kristina Drusany Staric ◽  
Adolf Lukanovic ◽  
Petra Petrocnik ◽  
Vita Zacesta ◽  
Corrado Cescon ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Endoanal Ultrasound ◽  
Sphincter Injury ◽  
Mediolateral Episiotomy ◽  
Anal Sphincter Injury ◽  
Obstetrical Anal Sphincter Injury

scholarly journals Mode of Vaginal Delivery: A Modifiable Intrapartum Risk Factor for Obstetric Anal Sphincter Injury

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Marta Simó González ◽  
Oriol Porta Roda ◽  
Josep Perelló Capó ◽  
Ignasi Gich Saladich ◽  
Joaquim Calaf Alsina
Keyword(s):  
Risk Factor ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
University Hospital ◽  
Obstetric Anal Sphincter Injury ◽  
Vacuum Extraction ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Vaginal Deliveries ◽  
Spontaneous Delivery

The aim of this study was to analyze the comparative risks of this anal sphincter injury in relation to the type of intervention in vaginal delivery. We performed an observational, retrospective study of all vaginal deliveries attended at a tertiary university hospital between January 2006 and December 2009. We analyzed the incidence of obstetric anal sphincter injury for each mode of vaginal delivery: spontaneous delivery, vacuum, Thierry spatulas, and forceps. We determined the proportional incidence between methods taking spontaneous delivery as the reference. Ninety-seven of 4526 (2.14%) women included in the study presented obstetric anal sphincter injury. Instrumental deliveries showed a significantly higher risk of anal sphincter injury (2.7 to 4.9%) than spontaneous deliveries (1.1%). The highest incidence was for Thierry spatulas (OR 4.804), followed by forceps (OR 4.089) and vacuum extraction (OR 2.509). The type of intervention in a vaginal delivery is a modifiable intrapartum risk factor for obstetric anal sphincter injury. Tearing can occur in any type of delivery but proportions vary significantly. All healthcare professionals attending childbirth should be aware of the risk for each type of intervention and consider these together with the obstetric factors in each case.

Obstetric anal sphincter injury and anal incontinence

2021 ◽  
Vol 86 (2) ◽  
pp. 118-122
Author(s):  
Jan Dvořák ◽  
◽  
Jaromír Mašata ◽  
Kamil Švabík ◽  
Alois Martan
Keyword(s):  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Anal Incontinence ◽  
Vacuum Extraction ◽  
Sphincter Injury ◽  
Assisted Vaginal Delivery ◽  
Anal Sphincter Injury ◽  
Current State ◽  
Complex Approach ◽  
Risk Patients

Overview Objective: The aim of our study is to clarify the problems of OASI (obstetric anal sphincter injuries) and anal incontinence and prevention of this injury. Methods: Review of articles in peer reviewed journals with the usage of Google Scholar function and PubMed. Conclusion: OASI is a severe injury which is more commonly associated with assisted vaginal delivery. This injury cannot be fully prevented, but its incidence can be averted by the usage of selective mediolateral episiotomy, or by other precautionary moves in high risk patients. The treatment of anal incontinence after OASI requires a complex approach and thorough examination. At first delivery, OASI is not a stern indication for caesarean section in accordance with current state of knowledge. Keywords: OASI – sphincter injury – anal incontinence – assisted vaginal delivery – vacuum-extraction – forceps

scholarly journals A core outcome set development for a French national prospective study about the effect of mediolateral episiotomy on obstetric anal sphincter injury during operative vaginal delivery (INSTRUMODA)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bertrand Gachon ◽  
◽  
Thomas Schmitz ◽  
France Artzner ◽  
Olivier Parant ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Maternal Morbidity ◽  
Core Outcome Set ◽  
Core Outcome ◽  
Operative Delivery ◽  
Sphincter Injury ◽  
Mediolateral Episiotomy ◽  
Anal Sphincter Injury ◽  
Outcome Set ◽  
One Year

Abstract Background We aimed at developing a core outcome and variables of interest set to investigate the effects of mediolateral episiotomy on Obstetric Anal Sphincter Injury (OASI) during and after operative delivery in nulliparous women in a large-scale one-year observational French study including 15,000 women (INSTRUMODA). Methods A list of outcomes and variables of interest was suggested to obstetricians participating in the INSTRUMODA study using online questionnaires divided into 7 categories: the woman’s history and course of pregnancy, course of labor, modalities of operative delivery, episiotomy characteristics, immediate maternal morbidity, one-year maternal morbidity, immediate neonatal morbidity. We used a three-round DELPHI method to reach a consensus. In the first round, outcomes and variables considered as essential by 70% or more of obstetricians were included in the corpus whereas they were excluded when 70% rated them as “not important”. In the second round, non-consensual outcomes and variables were reassessed and excluded or definitively included if considered as “not important” or essential by 50% or more of the obstetricians. During the first round, obstetricians were invited to suggest new outcomes and/or variables that were then assessed in the second and third round. We used the same method to develop a core outcome and variables of interest set in a population of women in the community recruited via an association of patients. At the end of the procedure the core outcome and variables of interest sets were merged to provide the final core outcome set for the INSTRUMODA study. Results Fifty-three obstetricians and 16 women filled out questionnaires. After the 3 rounds of Delphi procedure in each population, 74 outcomes and variables were consensually reported by obstetricians and 92 by women in the community. By mixing these two consensual corpora we reported a final consensual list of 114 variables of interest and outcomes for both obstetricians and women. Conclusion We established a core outcome and variables of interest set among obstetricians and women in the community to investigate the association between mediolateral episiotomy and OASI during operative delivery. Trial registration The INSTRUMODA study was registered on https://clinicaltrials.gov on June 25, 2020 (NCT04446780).

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