ArticleArchives of gynecology and obstetrics2020
Does birthweight have a role in the effect of episiotomy on anal sphincter injury?
Article in Archives of gynecology and obstetrics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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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.
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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.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- 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
- Short-Term and Long-Term Outcomes and Predictors of Complications Following Major Obstetric Anal Sphincter Injuries.International urogynecology journal · 2026Article
- Berlin survey on obstetric anal sphincter injury (OASI).Archives of gynecology and obstetrics · 2022Article
- The association between vacuum-assisted vaginal delivery and anal sphincter injury.International urogynecology journal · 2021Article
- Sonographic fetal head circumference and the risk of obstetric anal sphincter injury following vaginal delivery.International urogynecology journal · 2020Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeMost professional guidelines advise against routine episiotomy during vaginal delivery, although mounting evidence supports its protective role regarding obstetric anal sphincter injury (OASI). We aimed to study the effect of lateral and mediolateral episiotomies on the rate of OASI in relation to birthweight among nulliparous women undergoing vaginal delivery.
methodsA historical cohort study was conducted of all nulliparous women who delivered vaginally at term between 2011 and 2019 at a tertiary university hospital. Women were allocated into two groups: (1) with OASI and (2) without OASI. Episiotomy performance and birthweight groups were analyzed.
resultsOverall, 22,250 deliveries were analyzed for inclusion: 18,533 (83.3%) spontaneous vaginal deliveries (SVD), 3222 (14.5%) vacuum-assisted deliveries (VAD) and 495 (2.2%) forceps deliveries. Total episiotomy and OASI rate was 48.2% and 1.7%, respectively. Episiotomy rate was lower in the OASI group as compared to the no OASI group (158 (41.3%) vs. 10,568 (48.3%), OR 0.75, 0.61-0.92, p = 0.006). Median birthweight was higher for OASI group neonates (3355 vs. 3160, p < 0.001). In SVDs, episiotomy decreased the rate of OASI in neonatal birthweight groups of 3000-3499, 3500-3999 and > 4000 g (OR 0.56, 0.38-0.82, p = 0.003; 0.66, 0.45-0.99, p = 0.04 and 0.24, 0.07-0.78, p = 0.01, respectively). In VADs, episiotomy decreased the rate of OASI in the neonatal weight groups of 2500-2999 and 3000-3499 g (OR 0.36, 0.14-0.89, p = 0.02 and OR 0.38, 0.19-0.75, p = 0.004, respectively).
conclusionsLateral and mediolateral episiotomies are independent modifiable predictors of OASI, protective against OASI in SVDs when neonates weigh > 3000 g and 2500-3499 g in VADs.
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