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Am J Obstet Gynecol. 2006 Sep;195(3):749-54.

Operative vaginal delivery and midline episiotomy: a bad combination for the perineum.

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1
Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.

Abstract

OBJECTIVE:

The purpose of this study was to determine the impact of operative vaginal delivery (forceps or vacuum) and midline episiotomy on the risk of severe perineal trauma.

STUDY DESIGN:

In this retrospective cohort study, we assessed the impact of maternal and obstetric factors on the risk of development of severe perineal trauma (third- and fourth-degree perineal lacerations) for all singleton, vertex vaginal live births (n = 33,842) between 1996 and 2003.

RESULTS:

Among nulliparous women, 12.1% had operative vaginal delivery, 22.4% had midline episiotomy, and 8.1% experienced severe perineal trauma. Among multiparous women, 3.4% had operative vaginal delivery, 4.2% had midline episiotomy, and 1.2% experienced severe perineal trauma. Controlling for maternal age, ethnicity, birth weight and head circumference, evaluation of the interaction of episiotomy and delivery method revealed that forceps (nulliparous women: odds ratio [OR] 8.6, 95% CI 6.5-10.7; multiparous women: OR 26.3, 95% CI 18.1-34.5) and episiotomy (nulliparous women: OR 4.5, 95% CI 3.7-5.4; multiparous women: OR 14.6, 95% CI 10.4-20.5) were consistently associated with the increased risk of anal sphincter trauma. In fact, the magnitude of effect of the statistically significant synergistic interaction was evidenced by more than 3-fold excess of risk of using operative vaginal delivery alone.

CONCLUSION:

The use of operative vaginal delivery, particularly in combination with midline episiotomy, was associated with a significant increase in the risk of anal sphincter trauma in both primigravid and multigravid women. Given the reported substantial long-term adverse consequences for anal function, this combination of operative modalities should be avoided if possible.

PMID:
16949408
DOI:
10.1016/j.ajog.2006.06.078
[Indexed for MEDLINE]
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