Evidence map›Paper›PMID 35426490›Full record

SynthesisInternational urogynecology journal2022

Mediolateral/lateral episiotomy with operative vaginal delivery and the risk reduction of obstetric anal sphincter injury (OASI): A systematic review and meta-analysis.

Nicola Adanna Okeahialam, Ka Woon Wong, Swati Jha, Abdul H Sultan, Ranee Thakar

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in International urogynecology journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 2 pooled it
6.8field-weighted citation impact, top 2% 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

23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 40 citations in OpenAlex.

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  12. National trends of episiotomy in non-instrumental vaginal deliveries (2013-2022): A multi-data source approach.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
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  19. 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 · 2025
    Article
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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

5 authors at 3 institutions in 1 country.

Nicola Adanna OkeahialamUrogynaecology Clinical Research Fellow, Croydon University Hospital, Croydon, UK.
Ka Woon WongUrogynaecology Subspecialty Registrar, Croydon University Hospital, Croydon, UK.
Swati JhaConsultant Obstetrician and Urogynaecologist, Department of Urogynaecology, Sheffield Teaching Hospitals, Sheffield, UK.
Abdul H SultanConsultant Obstetrician and Urogynaecologist, Croydon University Hospital, Croydon, UK.
Ranee ThakarConsultant Obstetrician and Urogynaecologist, Croydon University Hospital, Croydon, UK. ranee.thakar@nhs.net.ORCID 0000-0002-5279-141X
Croydon University Hospital · GBSt George's, University of London · GBSheffield Teaching Hospitals NHS Foundation Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introduction and hypothesisOASI complicates approximately 6% of vaginal deliveries. This risk is increased with operative vaginal deliveries (OVDs), particularly forceps. However, there is conflicting evidence supporting the use of mediolateral/lateral episiotomy (MLE/LE) with OVD. The aim of this study was to assess whether MLE/LE affects the incidence of OASI in OVD.

methodsElectronic searches were performed in OVID Medline, Embase and the Cochrane Library. Randomised and non-randomised observational studies investigating the risk of OASI in OVD with/without MLE/LE were eligible for inclusion. Pooled odds ratios (OR) were calculated using Revman 5.3. Risk of bias of was assessed using the Cochrane RoB2 and ROBINS-I tool. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

resultsA total of 703,977 patients from 31 studies were pooled for meta-analysis. MLE/LE significantly reduced the rate of OASI in OVD (OR 0.60 [95% CI 0.42-0.84]). On sub-group analysis, MLE/LE significantly reduced the rate in nulliparous ventouse (OR 0.51 [95% CI 0.42-0.84]) and forceps deliveries (OR 0.32 [95% CI 0.29-0.61]). In multiparous women, although the incidence of OASI was lower when a ventouse or forceps delivery was performed with an MLE/LE, this was not statistically significant. Heterogeneity remained significant across all studies (I

conclusionsMLE/LE may reduce the incidence of OASI in OVDs, particularly in nulliparous ventouse or forceps deliveries. This information will be useful in aiding clinical decision-making and counselling in the antenatal period and during labour.

Indexed as

EpisiotomyObstetric Labor ComplicationsAnal CanalDelivery, ObstetricFemaleHumansPregnancyRetrospective StudiesRisk FactorsRisk Reduction BehaviorLateral episiotomyMediolateral episiotomyObstetric anal sphincter injuryOperative vaginal delivery

Identifiers

PMID35426490
PMCPMC9206628
OpenAlexW4224078284

What OpenQuestion holds

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LicenceCC BY
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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.