Evidence map›Paper›PMID 35045812›Full record

Observational studyBMC pregnancy and childbirth2022

Mediolateral episiotomy and risk of obstetric anal sphincter injuries and adverse neonatal outcomes during operative vaginal delivery in nulliparous women: a propensity-score analysis.

Thomas Desplanches, Laetitia Marchand-Martin, Emilie-Denise Szczepanski, Marie Ruillier, Jonathan Cottenet, Denis Semama, Emmanuel Simon, Catherine Quantin, Paul Sagot

Open access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC pregnancy and childbirth, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 2 pooled it
2.2field-weighted citation impact, top 12% 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

12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.

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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

9 authors at 3 institutions in 1 country.

Thomas DesplanchesDijon University Hospital, Burgundy Perinatal Network, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, F-21000, Dijon, France. thomas.desplanches@inserm.fr.
Laetitia Marchand-MartinObstetrical, Perinatal and Pediatric Epidemiology Team (EPOPé), Center of Research in Epidemiology and Statistics (U1153), Team EPOPé U1153, Université de Paris, Inserm, Paris, France.
Emilie-Denise SzczepanskiDijon University Hospital, Burgundy Perinatal Network, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, F-21000, Dijon, France.
Marie RuillierDijon University Hospital, Burgundy Perinatal Network, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, F-21000, Dijon, France.
Jonathan CottenetDijon University Hospital, Service de Biostatistique et d'Informatique Médicale (DIM), F-21000, Dijon, France.
Denis SemamaDijon University Hospital, Pôle de Pédiatrie, F-21000, Dijon, France.
Emmanuel SimonDijon University Hospital, Burgundy Perinatal Network, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, F-21000, Dijon, France.
Catherine QuantinDijon University Hospital, Service de Biostatistique et d'Informatique Médicale (DIM), F-21000, Dijon, France.
Paul SagotDijon University Hospital, Burgundy Perinatal Network, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, F-21000, Dijon, France.
Inserm · FRMaison des Sciences de l’Homme de Dijon · FRUniversité Paris Cité · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe potential protective effect of mediolateral episiotomy for obstetrical anal sphincter injuries (OASIs) remains controversial during operative vaginal delivery because of the difficulties to take into account the risk factors and clinical conditions at delivery; in addition, little is known about the potential benefits of mediolateral episiotomy on neonatal outcomes. The objectives were to investigate the associations between mediolateral episiotomy and both OASIs and neonatal outcomes, using propensity scores.

methodsWe performed a retrospective population-based observational study from a perinatal registry that includes all births in a French region between 2010 and 2017. All nulliparous women with singleton pregnancy delivering by operative vaginal deliveries at 37 weeks gestational age or later were included. Inverse-probability-of-treatment weighting with propensity scores was used to minimize indication bias. OASIs was defined as third and fourth-degree tears according to Royal College of Obstetricians and Gynecologists. Two neonatal outcomes were studied: condition at birth (5-min Apgar score less than 7 and/or umbilical artery pH less than 7.10), and admission to neonatal intensive care unit.

resultsThe study population consisted of 7589 women; 2880 (38.0%) received mediolateral episiotomy. After applying propensity scores, episiotomy was associated with a lower rate of OASIs in forceps/spatula delivery (2.3 vs 6.8%, Risk Ratio (RR) 0.38, 95% Confidence Interval (CI) 0.28-0.52) and in vacuum delivery (1.3 vs 3.4%, RR 0.27, 95% CI 0.20-0.38) as compared with no episiotomy. Mediolateral episiotomy was associated with better condition at birth in case of forceps/spatula delivery (4.5 vs 8.8%, RR 0.56, 95% CI 0.39-0.81). In cases of fetal distress (40.7%), mediolateral episiotomy was associated with better condition of infant at birth in women who delivered by forceps/spatula (4.2 vs 13.5%, RR 0.52, 95% CI 0.31-0.89). No association was found with neonatal unit admission (RR 0.93, 95% CI 0.50-1.74).

conclusionsUse of mediolateral episiotomy was associated with a lower rate of OASIs during operative vaginal delivery, and in infants it was associated with better condition at birth following forceps/spatula delivery.

Indexed as

ParityPropensity ScoreAnal CanalApgar ScoreDelivery, ObstetricEpisiotomyFemaleFetal DistressFranceHumansInfant, NewbornIntensive Care Units, NeonatalOdds RatioPregnancyRetrospective StudiesAdverse neonatal outcomesEpisiotomyObstetric anal sphincter injuriesOperative vaginal deliveriesPropensity score

Identifiers

PMID35045812
PMCPMC8772124
OpenAlexW4206758203

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

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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.