干旱区生态环境知识资源中心(Arid): Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study

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DOI	10.1111/aogs.14742
	Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study
	Eggebo, Torbjorn M.; Rygh, Astrid Betten; von Brandis, Phillip; Skjeldestad, Finn Egil
通讯作者	Eggebo, TM
来源期刊	ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA
ISSN	0001-6349
EISSN	1600-0412
出版年	2024
卷号	103 期号:3 页码:488-497
英文摘要	IntroductionThere are many risk factors for obstetric anal sphincter injury (OASIS) and the interaction between these risk factors is complex and understudied. The many observational studies that have shown a reduction of OASIS rates after implementation of perineal support have short follow-up time. We aimed to study the effect of integration of active perineal support and lateral episiotomy on OASIS rates over a 15-year period and to study interactions between risk factors known before delivery.Material and methodsWe performed a historical cohort study over the periods 1999-2006 and 2007-2021 at Stavanger University Hospital, Norway. The main outcome was OASIS rates. Women without a previous cesarean section and a live singleton fetus in cephalic presentation at term were eligible. The department implemented in 2007 the Finnish concept of active perineal protection, which includes support of perineum, control of fetal expulsion, good communication with the mother and observation of perineal stretching. The practice of mediolateral episiotomy was replaced with lateral episiotomy when indicated. We analyzed the OASIS rates in groups with and without episiotomy stratified for delivery mode, fetal position at delivery and for parity, and adjusted for possible confounders (maternal age, gestational age, oxytocin augmentation and epidural analgesia).ResultsWe observed a long-lasting reduction in OASIS rates from 4.9% to 1.9% and an increase in episiotomy rates from 14.4% to 21.8%. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with instrumental vaginal deliveries and occiput anterior (OA) position; 3.4% versus 10.1% (OR 0.31; 95% CI: 0.24-0.40) and 6.1 versus 13.9% (OR 0.40; 95% CI: 0.19-0.82) in women with occiput posterior (OP) position. Lateral episiotomy was also associated with lower OASIS rates in nulliparous women with spontaneous deliveries and OA position; 2.1% versus 3.2% (OR 0.62; 95% CI: 0.49-0.80). The possible confounders had little confounding effects on the risk of OASIS in groups with and without episiotomy.ConclusionsWe observed a long-lasting reduction in OASIS rates after implementation of preventive procedures. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with an instrumental delivery. Special attention should be paid to deliveries with persistent OP position. Obstetric anal sphincter injuries rates during the study period differentiated in accordance with the Robson ten-group classification system. Blue line represents Robson ten-group classification system group 1, green line group 2, brown line group 3 and red line group 4.image
英文关键词	delivery mode episiotomy fetal position OASIS parity
类型	Article
语种	英语
开放获取类型	Green Published, hybrid
收录类别	SCI-E
WOS记录号	WOS:001113214100001
WOS关键词	OPERATIVE VAGINAL DELIVERY ; FETAL HEAD POSITION ; RISK-FACTORS ; MEDIOLATERAL EPISIOTOMY ; ROUTINE ; REDUCE ; TEARS
WOS类目	Obstetrics & Gynecology
WOS研究方向	Obstetrics & Gynecology
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/402600
推荐引用方式 GB/T 7714	Eggebo, Torbjorn M.,Rygh, Astrid Betten,von Brandis, Phillip,et al. Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study[J],2024,103(3):488-497.
APA	Eggebo, Torbjorn M.,Rygh, Astrid Betten,von Brandis, Phillip,&Skjeldestad, Finn Egil.(2024).Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study.ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA,103(3),488-497.
MLA	Eggebo, Torbjorn M.,et al."Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study".ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA 103.3(2024):488-497.