Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study
Please cite this paper as: Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, Øian P. Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case‐control study. BJOG 2012;119:724–730. Objectives To investigate the association between the geometrical properties of episio...
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| creator | Stedenfeldt, M Pirhonen, J Blix, E Wilsgaard, T Vonen, B Øian, P |
| description | Please cite this paper as: Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, Øian P. Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case‐control study. BJOG 2012;119:724–730.
Objectives To investigate the association between the geometrical properties of episiotomy and obstetric anal sphincter injuries (OASIS) because episiotomies angled at 40–60° are associated with fewer OASIS than episiotomies with more acute angles.
Design Case–control study.
Setting University Hospital of North Norway, Tromsø and Nordland Hospital, Bodø, Norway.
Sample Seventy‐four women who had one vaginal birth and episiotomy. Cases (n = 37) have sustained OASIS at birth, while controls (n = 37) had not. The groups were matched for instrumental delivery.
Methods Two groups of women with history of only one vaginal birth were compared. Episiotomy scar was identified and photographed and relevant measures were taken. Data were analysed using conditional logistic analysis.
Main outcome measures Mean episiotomy angle, length, depth, incision point.
Results The risk of sustaining OASIS decreased by 70% (odds ratio [OR] 0.30; 95% CI 0.14–0.66) for each 5.5‐mm increase in episiotomy depth, decreased by 56% (OR 0.44; 95% CI 0.23–0.86) for each 4.5‐mm increase in the distance from the midline to the incision point of the episiotomy, and decreased by 75% (OR 0.25; 95% CI 0.10–0.61) for each 5.5‐mm increase in episiotomy length. Lastly, there was no difference in mean angle between groups but there was a “U‐shaped” association between angle and OASIS (OR 2.09; 95% CI 1.02–4.28) with an increased risk (OR 9.00; 95% CI 1.1–71.0) of OASIS when the angle was either smaller than 15°or >60°.
Conclusion The present study showed that scarred episiotomies with depth > 16 mm, length > 17 mm, incision point > 9 mm lateral of midpoint and angle range 30–60° are significantly associated with less risk of OASIS. Shrinkage of tissue must be considered. |
| doi_str_mv | 10.1111/j.1471-0528.2012.03293.x |
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Objectives To investigate the association between the geometrical properties of episiotomy and obstetric anal sphincter injuries (OASIS) because episiotomies angled at 40–60° are associated with fewer OASIS than episiotomies with more acute angles.
Design Case–control study.
Setting University Hospital of North Norway, Tromsø and Nordland Hospital, Bodø, Norway.
Sample Seventy‐four women who had one vaginal birth and episiotomy. Cases (n = 37) have sustained OASIS at birth, while controls (n = 37) had not. The groups were matched for instrumental delivery.
Methods Two groups of women with history of only one vaginal birth were compared. Episiotomy scar was identified and photographed and relevant measures were taken. Data were analysed using conditional logistic analysis.
Main outcome measures Mean episiotomy angle, length, depth, incision point.
Results The risk of sustaining OASIS decreased by 70% (odds ratio [OR] 0.30; 95% CI 0.14–0.66) for each 5.5‐mm increase in episiotomy depth, decreased by 56% (OR 0.44; 95% CI 0.23–0.86) for each 4.5‐mm increase in the distance from the midline to the incision point of the episiotomy, and decreased by 75% (OR 0.25; 95% CI 0.10–0.61) for each 5.5‐mm increase in episiotomy length. Lastly, there was no difference in mean angle between groups but there was a “U‐shaped” association between angle and OASIS (OR 2.09; 95% CI 1.02–4.28) with an increased risk (OR 9.00; 95% CI 1.1–71.0) of OASIS when the angle was either smaller than 15°or >60°.
Conclusion The present study showed that scarred episiotomies with depth > 16 mm, length > 17 mm, incision point > 9 mm lateral of midpoint and angle range 30–60° are significantly associated with less risk of OASIS. Shrinkage of tissue must be considered.</description><identifier>ISSN: 1470-0328</identifier><identifier>EISSN: 1471-0528</identifier><identifier>DOI: 10.1111/j.1471-0528.2012.03293.x</identifier><identifier>PMID: 22390647</identifier><identifier>CODEN: BIOGFQ</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Anal Canal - injuries ; Biological and medical sciences ; Case-Control Studies ; Childbirth & labor ; Clinical medical disciplines: 750 ; Delivery. Postpartum. Lactation ; Episiotomy ; Episiotomy - adverse effects ; Episiotomy - methods ; episiotomy technique ; Female ; General Obstetrics ; Gynecology and obstetrics: 756 ; Gynecology. Andrology. Obstetrics ; Gynekologi og obstetrikk: 756 ; Humans ; Injuries ; Klinisk medisinske fag: 750 ; Medical disciplines: 700 ; Medical sciences ; Medisinske Fag: 700 ; obstetric anal sphincter injuries ; Obstetric Labor Complications - etiology ; Obstetric Labor Complications - surgery ; Pregnancy ; Risk Factors ; Surgical techniques ; vaginal birth ; VDP</subject><ispartof>BJOG : an international journal of obstetrics and gynaecology, 2012-05, Vol.119 (6), p.724-730</ispartof><rights>2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG</rights><rights>2015 INIST-CNRS</rights><rights>2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.</rights><rights>info:eu-repo/semantics/openAccess</rights><rights>2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5923-6eb03d949cf44c3b220c6b91352a28719916cd3df2015ed96cc8d72951ec36b3</citedby><cites>FETCH-LOGICAL-c5923-6eb03d949cf44c3b220c6b91352a28719916cd3df2015ed96cc8d72951ec36b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1471-0528.2012.03293.x$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1471-0528.2012.03293.x$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,26544,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25784000$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22390647$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stedenfeldt, M</creatorcontrib><creatorcontrib>Pirhonen, J</creatorcontrib><creatorcontrib>Blix, E</creatorcontrib><creatorcontrib>Wilsgaard, T</creatorcontrib><creatorcontrib>Vonen, B</creatorcontrib><creatorcontrib>Øian, P</creatorcontrib><title>Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study</title><title>BJOG : an international journal of obstetrics and gynaecology</title><addtitle>BJOG</addtitle><description>Please cite this paper as: Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, Øian P. Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case‐control study. BJOG 2012;119:724–730.
Objectives To investigate the association between the geometrical properties of episiotomy and obstetric anal sphincter injuries (OASIS) because episiotomies angled at 40–60° are associated with fewer OASIS than episiotomies with more acute angles.
Design Case–control study.
Setting University Hospital of North Norway, Tromsø and Nordland Hospital, Bodø, Norway.
Sample Seventy‐four women who had one vaginal birth and episiotomy. Cases (n = 37) have sustained OASIS at birth, while controls (n = 37) had not. The groups were matched for instrumental delivery.
Methods Two groups of women with history of only one vaginal birth were compared. Episiotomy scar was identified and photographed and relevant measures were taken. Data were analysed using conditional logistic analysis.
Main outcome measures Mean episiotomy angle, length, depth, incision point.
Results The risk of sustaining OASIS decreased by 70% (odds ratio [OR] 0.30; 95% CI 0.14–0.66) for each 5.5‐mm increase in episiotomy depth, decreased by 56% (OR 0.44; 95% CI 0.23–0.86) for each 4.5‐mm increase in the distance from the midline to the incision point of the episiotomy, and decreased by 75% (OR 0.25; 95% CI 0.10–0.61) for each 5.5‐mm increase in episiotomy length. Lastly, there was no difference in mean angle between groups but there was a “U‐shaped” association between angle and OASIS (OR 2.09; 95% CI 1.02–4.28) with an increased risk (OR 9.00; 95% CI 1.1–71.0) of OASIS when the angle was either smaller than 15°or >60°.
Conclusion The present study showed that scarred episiotomies with depth > 16 mm, length > 17 mm, incision point > 9 mm lateral of midpoint and angle range 30–60° are significantly associated with less risk of OASIS. Shrinkage of tissue must be considered.</description><subject>Adult</subject><subject>Anal Canal - injuries</subject><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Childbirth & labor</subject><subject>Clinical medical disciplines: 750</subject><subject>Delivery. Postpartum. Lactation</subject><subject>Episiotomy</subject><subject>Episiotomy - adverse effects</subject><subject>Episiotomy - methods</subject><subject>episiotomy technique</subject><subject>Female</subject><subject>General Obstetrics</subject><subject>Gynecology and obstetrics: 756</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Gynekologi og obstetrikk: 756</subject><subject>Humans</subject><subject>Injuries</subject><subject>Klinisk medisinske fag: 750</subject><subject>Medical disciplines: 700</subject><subject>Medical sciences</subject><subject>Medisinske Fag: 700</subject><subject>obstetric anal sphincter injuries</subject><subject>Obstetric Labor Complications - etiology</subject><subject>Obstetric Labor Complications - surgery</subject><subject>Pregnancy</subject><subject>Risk Factors</subject><subject>Surgical techniques</subject><subject>vaginal birth</subject><subject>VDP</subject><issn>1470-0328</issn><issn>1471-0528</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><sourceid>3HK</sourceid><recordid>eNqNkd9v0zAQxy0EYlvhX0AREhIvCf4RxzESk2AahWmwl0l9PBzHoe7SuNjJaP97nKbrBE_4xSff57535y9CCcEZiefdKiO5ICnmtMwoJjTDjEqWbZ-g02Pi6T7GaUyVJ-gshBXGpKCYPUcnlDKJi1ycoh-XGxus6916l-il8kr3xtvQWx0S1dVJjO9C0jifuCr0pvdWx3fVJmGztN0IJ7ZbDd6a8D5RiVbBpNp1vXcR6Yd69wI9a1QbzMvDPUO3ny9vL76k1zfzrxcfr1PNJWVpYSrMaplL3eS5ZhWlWBeVJIxTRUtBpCSFrlndxHW5qWWhdVkLKjkxmhUVm6HzSXYzVGtTaxNHUC1svF0rvwOnLPyd6ewSfrp7YHkpMRNR4NUkoPfrd9A5r4DgmAM-AW8PHbz7NZjQw9oGbdpWdcYNIaKEY8lEWUT09T_oyg0-_loAKamUAvNRr3xo6ELwpjkOSzCMLsMKRjNhNBNGl2HvMmwfZ51WOhY-2BqBNwdABa3axqtO2_DIcVHmOK42Qx8m7rdtze6_B4BPVzdjFOvTqT5-mdke65W_g0IwwWHxfQ5UXOXf-HwBC_YH1YHRyQ</recordid><startdate>201205</startdate><enddate>201205</enddate><creator>Stedenfeldt, M</creator><creator>Pirhonen, J</creator><creator>Blix, E</creator><creator>Wilsgaard, T</creator><creator>Vonen, B</creator><creator>Øian, P</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><general>Wiley Subscription Services, Inc</general><general>Blackwell Science Ltd</general><scope>BSCLL</scope><scope>24P</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>7X8</scope><scope>3HK</scope><scope>5PM</scope></search><sort><creationdate>201205</creationdate><title>Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study</title><author>Stedenfeldt, M ; Pirhonen, J ; Blix, E ; Wilsgaard, T ; Vonen, B ; Øian, P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5923-6eb03d949cf44c3b220c6b91352a28719916cd3df2015ed96cc8d72951ec36b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Anal Canal - injuries</topic><topic>Biological and medical sciences</topic><topic>Case-Control Studies</topic><topic>Childbirth & labor</topic><topic>Clinical medical disciplines: 750</topic><topic>Delivery. Postpartum. Lactation</topic><topic>Episiotomy</topic><topic>Episiotomy - adverse effects</topic><topic>Episiotomy - methods</topic><topic>episiotomy technique</topic><topic>Female</topic><topic>General Obstetrics</topic><topic>Gynecology and obstetrics: 756</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Gynekologi og obstetrikk: 756</topic><topic>Humans</topic><topic>Injuries</topic><topic>Klinisk medisinske fag: 750</topic><topic>Medical disciplines: 700</topic><topic>Medical sciences</topic><topic>Medisinske Fag: 700</topic><topic>obstetric anal sphincter injuries</topic><topic>Obstetric Labor Complications - etiology</topic><topic>Obstetric Labor Complications - surgery</topic><topic>Pregnancy</topic><topic>Risk Factors</topic><topic>Surgical techniques</topic><topic>vaginal birth</topic><topic>VDP</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stedenfeldt, M</creatorcontrib><creatorcontrib>Pirhonen, J</creatorcontrib><creatorcontrib>Blix, E</creatorcontrib><creatorcontrib>Wilsgaard, T</creatorcontrib><creatorcontrib>Vonen, B</creatorcontrib><creatorcontrib>Øian, P</creatorcontrib><collection>Istex</collection><collection>Wiley Online Library Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>NORA - Norwegian Open Research Archives</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stedenfeldt, M</au><au>Pirhonen, J</au><au>Blix, E</au><au>Wilsgaard, T</au><au>Vonen, B</au><au>Øian, P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study</atitle><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle><addtitle>BJOG</addtitle><date>2012-05</date><risdate>2012</risdate><volume>119</volume><issue>6</issue><spage>724</spage><epage>730</epage><pages>724-730</pages><issn>1470-0328</issn><eissn>1471-0528</eissn><coden>BIOGFQ</coden><abstract>Please cite this paper as: Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, Øian P. Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case‐control study. BJOG 2012;119:724–730.
Objectives To investigate the association between the geometrical properties of episiotomy and obstetric anal sphincter injuries (OASIS) because episiotomies angled at 40–60° are associated with fewer OASIS than episiotomies with more acute angles.
Design Case–control study.
Setting University Hospital of North Norway, Tromsø and Nordland Hospital, Bodø, Norway.
Sample Seventy‐four women who had one vaginal birth and episiotomy. Cases (n = 37) have sustained OASIS at birth, while controls (n = 37) had not. The groups were matched for instrumental delivery.
Methods Two groups of women with history of only one vaginal birth were compared. Episiotomy scar was identified and photographed and relevant measures were taken. Data were analysed using conditional logistic analysis.
Main outcome measures Mean episiotomy angle, length, depth, incision point.
Results The risk of sustaining OASIS decreased by 70% (odds ratio [OR] 0.30; 95% CI 0.14–0.66) for each 5.5‐mm increase in episiotomy depth, decreased by 56% (OR 0.44; 95% CI 0.23–0.86) for each 4.5‐mm increase in the distance from the midline to the incision point of the episiotomy, and decreased by 75% (OR 0.25; 95% CI 0.10–0.61) for each 5.5‐mm increase in episiotomy length. Lastly, there was no difference in mean angle between groups but there was a “U‐shaped” association between angle and OASIS (OR 2.09; 95% CI 1.02–4.28) with an increased risk (OR 9.00; 95% CI 1.1–71.0) of OASIS when the angle was either smaller than 15°or >60°.
Conclusion The present study showed that scarred episiotomies with depth > 16 mm, length > 17 mm, incision point > 9 mm lateral of midpoint and angle range 30–60° are significantly associated with less risk of OASIS. Shrinkage of tissue must be considered.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>22390647</pmid><doi>10.1111/j.1471-0528.2012.03293.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Anal Canal - injuries Biological and medical sciences Case-Control Studies Childbirth & labor Clinical medical disciplines: 750 Delivery. Postpartum. Lactation Episiotomy Episiotomy - adverse effects Episiotomy - methods episiotomy technique Female General Obstetrics Gynecology and obstetrics: 756 Gynecology. Andrology. Obstetrics Gynekologi og obstetrikk: 756 Humans Injuries Klinisk medisinske fag: 750 Medical disciplines: 700 Medical sciences Medisinske Fag: 700 obstetric anal sphincter injuries Obstetric Labor Complications - etiology Obstetric Labor Complications - surgery Pregnancy Risk Factors Surgical techniques vaginal birth VDP |
| title | Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study |
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