ArticleInternational urogynecology journal2018
The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of a national registry.
Article in International urogynecology journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 2 of them syntheses that pooled it.
What it found
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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.
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.
Who cites it
36 citing papers in PubMed, 2 syntheses or guidelines pooled it, 113 citations in OpenAlex.
- Caesarean section and anal incontinence in women after obstetric anal sphincter injury: A systematic review and meta-analysis.BJOG : an international journal of obstetrics and gynaecology · 2025Pooled it
- Mediolateral/lateral episiotomy with operative vaginal delivery and the risk reduction of obstetric anal sphincter injury (OASI): A systematic review and meta-analysis.International urogynecology journal · 2022Pooled it
- Obstetric Anal Sphincter Injury After Episiometer-Guided Versus Conventional Episiotomy in Instrumental Deliveries: A Randomized Controlled Trial.International urogynecology journal · 2024Trial
- Lateral episiotomy or no episiotomy in vacuum assisted delivery in nulliparous women (EVA): multicentre, open label, randomised controlled trial.BMJ (Clinical research ed.) · 2024Trial
- Prediction of Obstetric Anal Sphincter Injury in Nulliparous Women: Model Development and Temporal Validation.BJOG : an international journal of obstetrics and gynaecology · 2026Article
- IUGA International Guidelines on Obstetric Anal Sphincter Injuries.International urogynecology journal · 2026Article
- Episiotomy in Operative Vaginal Delivery Reduces the Risk of Obstetric Anal Sphincter Injuries in Nulliparous Women: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2026Review
- Episiotomy and Obstetric Anal Sphincter Injury in the Setting of Instrumental Vaginal Birth: A Retrospective Cohort Study.The Australian & New Zealand journal of obstetrics & gynaecology · 2026Article
- Mediolateral episiotomy and obstetric anal sphincter injuries in nullipara: a propensity score matching study.BMC pregnancy and childbirth · 2025Article
- Incidence of obstetric anal sphincter injuries according to the type of forceps used in the Mexican population.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025Article
- Episiotomies and obstetric anal sphincter injuries following a restrictive episiotomy policy in France: An analysis of the 2010, 2016, and 2021 National Perinatal Surveys.PLoS medicine · 2025Article
- Predictors and Unexplained Variability of Obstetric Anal Sphincter Injuries: A Population-Based Cross-Sectional Analysis.International urogynecology journal · 2025Article
- Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study.Acta obstetricia et gynecologica Scandinavica · 2024Article
- Episiotomy practice in France and prevention of high-grade perineal tears at the time of operative vaginal delivery: a prospective multicentre ancillary cohort study.International urogynecology journal · 2024Article
- The effect of postpartum nursing guidance on early pelvic floor dysfunction recovery in women of advanced maternal age: a randomized controlled trial.Frontiers in medicine · 2024Article
- Article
- The association between episiotomy or OASIS at vacuum extraction in nulliparous women and subsequent prelabor cesarean delivery: A nationwide observational study.Acta obstetricia et gynecologica Scandinavica · 2023Observational
- Perineal stress as a predictor of performing episiotomy in primiparous women: a prospective observational study.BMC pregnancy and childbirth · 2022Observational
- Berlin survey on obstetric anal sphincter injury (OASI).Archives of gynecology and obstetrics · 2022Article
- French guidelines for restrictive episiotomy during instrumental delivery were not followed by an increase in obstetric anal sphincter injury.Scientific reports · 2022Article
Corrections and comments
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Authors and funding
8 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introduction and hypothesisObstetric anal sphincter injuries (OASIS) are associated with an increased risk of faecal incontinence after vaginal delivery. The aim of this retrospective population-based cohort study was to assess whether mediolateral episiotomy is associated with a reduction in the rate of OASIS during operative vaginal delivery.
methodsWe used data from the Dutch Perinatal Registry (Perined) that includes records of almost all births between 2000 and 2010 in The Netherlands. In a cohort of 170,969 primiparous and multiparous women whose delivery was recorded, we estimated the association between mediolateral episiotomy and OASIS following both vacuum and forceps deliveries using univariate and multivariate logistic regression analysis.
resultsThe incidences of OASIS following vacuum delivery in 130,157 primiparous women were 2.5% and 14% in those with and without a mediolateral episiotomy, respectively (adjusted OR 0.14, 95% CI 0.13-0.15), and in 29,183 multiparous women were 2.0% and 7.5%, respectively (adjusted OR 0.23, 95% CI 0.21-0.27). The incidences of OASIS following forceps delivery in 9,855 primiparous women were 3.4% and 26.7% in those with and without a mediolateral episiotomy, respectively (adjusted OR 0.09, 95% CI 0.07-0.11), and in 1,774 multiparous women were 2.6% and 14.2%, respectively (adjusted OR 0.13, 95% CI 0.08-0.22).
conclusionsThe use of a mediolateral episiotomy during both vacuum delivery and forceps delivery is associated with a fivefold to tenfold reduction in the rate of OASIS in primiparous and multiparous women.
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