Evidence map›Paper›PMID 26044511›Full record

ReviewInternational urogynecology journal2015

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions.

Dharmesh S Kapoor, Ranee Thakar, Abdul H Sultan

Abstract readReview
PubMed Publisher
In one paragraph

Review in International urogynecology journal, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed
4.0field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 58 citations in OpenAlex.

  1. Trial
  2. Article
  3. Article
  4. Trigonometric characteristics of episiotomy & pregnancy variables.European journal of obstetrics & gynecology and reproductive biology: X · 2025
    Article
  5. Review
  6. Article
  7. Article
  8. Article
  9. Observational
  10. Berlin survey on obstetric anal sphincter injury (OASI).Archives of gynecology and obstetrics · 2022
    Article
  11. Article
  12. Observational
  13. Article
  14. Review
  15. FIGO good clinical practice paper: management of the second stage of labor.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2021
    Article
  16. A one-stop perineal clinic: our eleven-year experience.International urogynecology journal · 2020
    Observational
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 3 institutions in 1 country.

Dharmesh S KapoorDepartment of Obstetrics and Gynaecology, Royal Bournemouth Hospital, Bournemouth, UK. Dharmesh.kapoor@rbch.nhs.uk.
Ranee ThakarCroydon University Hospital, Croydon, UK. ranee.thakar@croydonhealth.nhs.uk.
Abdul H SultanCroydon University Hospital, Croydon, UK. asultan@doctors.org.uk.
Croydon University Hospital · GBRoyal Bournemouth Hospital · GBSt George's, University of London · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introduction and hypothesisObstetric anal sphincter injuries (OASIs) are the leading cause of anal incontinence in women. Modification of various risk factors and anatomical considerations have been reported to reduce the rate of OASI.

methodsA PubMed search (1989-2014) of studies and systematic reviews on risk factors for OASI.

resultsPerineal distension (stretching) of 170 % in the transverse direction and 40 % in the vertical direction occurs at crowning, leading to significant differences (15-30°) between episiotomy incision angles and suture angles. Episiotomies incised at 60° achieve suture angles of 43-50°; those incised at 40° result in a suture angle of 22°. Episiotomies with suture angles too acute (<30°) and too lateral (>60°) are associated with an increased risk of OASI. Suture angles of 40-60° are in the safe zone. Clinicians are poor at correctly estimating episiotomy angles on paper and in patients. Sutured episiotomies originating 10 mm away from the midline are associated with a lower rate of OASIs. Compared to spontaneous tears, episiotomies appear to be associated with a reduction in OASI risk by 40-50 %, whereas shorter perineal lengths, perineal oedema and instrumental deliveries are associated with a higher risk. Instrumental deliveries with mediolateral episiotomies are associated with a significantly lower OASI risk. Other preventative measures include warm perineal compresses and controlled delivery of the head.

conclusionsRelieving pressure on the central posterior perineum by an episiotomy and/or controlled delivery of the head should be important considerations in reducing the risk of OASI. Episiotomies should be performed 60° from the midline. Prospective studies should evaluate elective episiotomies in women with a short perineal length and application of standardised digital perineal support.

Indexed as

Anal CanalDelivery, ObstetricFemaleHumansLabor Stage, SecondPerineumPregnancyRisk FactorsAnal incontinenceEpisiotomyObstetric anal sphincter injuriesPerineal body lengthPerineal distensionThird and fourth degree perineal tears

Identifiers

PMID26044511
OpenAlexW644996662

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.