ArticleScientific reports2022
French guidelines for restrictive episiotomy during instrumental delivery were not followed by an increase in obstetric anal sphincter injury.
Article in Scientific reports, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 8 citations in OpenAlex.
- Levator Ani Muscle Avulsion After Soft Cup Vacuum-Assisted Versus Spontaneous Vaginal Delivery: A 3D Transperineal Ultrasound Study.International urogynecology journal · 2026Article
- Selective episiotomy guided by a perineal evaluation form for forceps-assisted vaginal delivery: a retrospective cohort study on maternal and neonatal outcomes.BMC pregnancy and childbirth · 2026Article
- 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
- Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study.Acta obstetricia et gynecologica Scandinavica · 2024Article
- Influence of the maternity unit and region of delivery on episiotomy practice in France: a nationwide population-based study.Acta obstetricia et gynecologica Scandinavica · 2023Article
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The objective was to assess the influence of the French guidelines in favor of a restrictive use of episiotomy on both episiotomy and obstetric anal sphincter injury (OASI) rates during instrumental delivery. It was aulticenter study involving 193 maternities between 2000 and 2016. We included women with a singleton pregnancy, with cephalic presentation at 34 weeks of gestation or more who underwent an instrumental delivery. The study period was divided into three phases: 2000-2005 (reference) 2006-2011, and 2012-2016. We calculated the adjusted relative risk (aRR) of episiotomy and OASI and investigated for changes in episiotomy and OASI rates over time by using Prais-Winsten regression. We considered 96,035 deliveries. The episiotomy's risk was lower in 2006-2011 (69.4%) and 2012-2016 (59.1%) compared to 2000-2005 (81.2%), respectively: aRR 0.93 [0.92-0.95] and 0.89 [0.87-0.90]. The OASI's risk was higher in 2006-2011 (2.5%) and 2012-2016 (3.1%) compared to 2000-2005, respectively: aRR 1.30 [1.10-1.53]) and 1.57 [1.33-1.85]. However, Prais-Winsten regression showed no difference in the OASI rate during the study period. We observed a massive decrease in episiotomy use and a moderate increase in crude OASI's rate but multivariate analysis failed to report an association between these outcomes.
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