Abstract
ObjectiveTo investigate the association between episiotomy and perineal damage in the subsequent delivery.Study designA retrospective cohort study was conducted, comparing outcome of subsequent singleton deliveries of women with and without episiotomy in their first (index) delivery. Deliveries occurred between the years 1991–2015 in a tertiary medical center. Traumatic vaginal tears, multiple pregnancies, and cesarean deliveries (CD) in the index pregnancy were excluded from the analysis. Multiple logistic regression models were used to control for confounders.ResultsDuring the study period, 43,066 women met the inclusion criteria; of them, 50.4% (n = 21,711) had subsequent delivery after episiotomy and 49.6% (n = 21,355) had subsequent delivery without episiotomy in the index pregnancy. Patients with episiotomy in the index birth higher rates of subsequent episiotomy (17.5 vs. 3.1%; P < 0.001; OR 1.9; 95% CI). In addition, the rates of the first and second degree perineal tears as well as the third and fourth degree perineal tears were significantly higher in patients following episiotomy (33.6 vs. 17.8%; P < 0.001, and 0.2 vs. 0.1%; P = 0.002, respectively). Nevertheless, there was no significant difference at the rates of CD and instrumental deliveries, between the groups. While adjusting for maternal age, ethnicity, birth weight, and vacuum delivery—the previous episiotomy was noted as an independent risk factor for recurrent episiotomy in the subsequent delivery (adjusted OR 6.7; 95% CI 6.2–7.3, P < 0.001). The results remained significant for term (adjusted OR 6.8; 95% CI 6.2–7.4, P < 0.001) as well as preterm deliveries (adjusted OR 4.5; 95% CI 3.3–6.3, P < 0.001) in two different models.ConclusionEpisiotomy is an independent risk factor for recurrent episiotomy in the subsequent delivery.
Highlights
The morbidity associated with perineal injury related to childbirth is a major health problem [1, 2]
In 2006, the American Congress of Obstetricians and Gynecologists recommended against routine episiotomy, and in 2008, the National Quality Forum recognized limiting routine episiotomy as an important measure of quality and patient safety, noting increased risks of pain, laceration, and anal incontinence with the procedure [10]
While adjusting for maternal age, ethnicity, birth weight, and vacuum birth, the previous episiotomy was found to be an independent risk factor for repeated episiotomy in the subsequent delivery
Summary
The morbidity associated with perineal injury related to childbirth is a major health problem [1, 2]. Most vaginal births are associated with some form of trauma to the genital tract, either perineal tear or episiotomy, following spontaneous vaginal delivery [3]. Episiotomy is a common obstetric procedure, performed with scissors or scalpel, and is. Restrictive use of episiotomy has been advocated given the risks of the procedure and unclear benefits of routine use [9]. In 2006, the American Congress of Obstetricians and Gynecologists recommended against routine episiotomy, and in 2008, the National Quality Forum recognized limiting routine episiotomy as an important measure of quality and patient safety, noting increased risks of pain, laceration, and anal incontinence with the procedure [10]. Since 2006, the episiotomy rate in the United States dropped from 17.3 to 11.6% in 2012 almost reaching 10% episiotomy rate that was recommended by the World Health Organization [11]
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