TEMPORAL TRENDS IN EPISIOTOMY USE AMONG SPONTANEOUS AND OPERATIVE VAGINAL DELIVERIES IN CANADA AND THE ASSOCIATION WITH OBSTETRIC ANAL SPHINCTER INJURY

Abstract

Objectives To quantify, firstly, temporal trends in episiotomy use among spontaneous vaginal deliveries (SVDs) and operative vaginal deliveries (OVDs) in Canada, and secondly, the associations between episiotomy and obstetric anal sphincter injury (OASI) among SVDs and OVDs. Methods Population-based, retrospective, cohort study of all singleton, term deliveries in Canada (2004-2014) using hospitalization data. Temporal trends in episiotomy use by parity, previous cesarean delivery and mode of delivery were tested using the Cochran-Armitage test. Logistic regression was used to estimate the association between episiotomy and OASI among women with SVD and OVD after controlling for confounders. Results The study included 1,442,484 deliveries. Among nulliparous women, there was a smaller absolute decline in episiotomy use among SVDs (22.9% in 2004 to 14.1% in 2014; p Conclusions Episiotomy use has declined in Canada in recent years among SVDs and OVDs. There is a pressing need to consider episiotomy use in OVD (especially with forceps) given the protective association between episiotomy and OASI.