ArticleActa obstetricia et gynecologica Scandinavica2024
Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study.
Article in Acta obstetricia et gynecologica Scandinavica, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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8 citing papers in PubMed, 16 citations in OpenAlex.
- Incidence and Independent Risk Factors for Obstetric Anal Sphincter Injuries: A Four-Year Retrospective Cohort Study from a UK Tertiary Maternity Unit.Journal of clinical medicine · 2026Article
- Secular Trends in Recurrent Obstetric Anal Sphincter Injuries among 297,190 Women in Norway: A Cohort Study.International urogynecology journal · 2026Article
- Obstetric Anal Sphincter Injuries: Risk Factors, Pelvic Floor Dysfunction, and Quality of Life Outcomes.Medicina (Kaunas, Lithuania) · 2026Article
- Fetal rotation examined with ultrasound in a sub-Saharan population: A longitudinal cohort study.Acta obstetricia et gynecologica Scandinavica · 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
- Associations between fetal position at delivery and duration of active phase of labor: A historical cohort study.Acta obstetricia et gynecologica Scandinavica · 2024Article
- The pelvic floor during pregnancy and delivery: Can pelvic floor trauma and disorders be prevented?Acta obstetricia et gynecologica Scandinavica · 2024Article
- Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study.Acta obstetricia et gynecologica Scandinavica · 2024Article
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Authors and funding
4 authors at 3 institutions in 1 country.
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Abstract
introductionThere are many risk factors for obstetric anal sphincter injury (OASIS) and the interaction between these risk factors is complex and understudied. The many observational studies that have shown a reduction of OASIS rates after implementation of perineal support have short follow-up time. We aimed to study the effect of integration of active perineal support and lateral episiotomy on OASIS rates over a 15-year period and to study interactions between risk factors known before delivery. MATERIAL AND
methodsWe performed a historical cohort study over the periods 1999-2006 and 2007-2021 at Stavanger University Hospital, Norway. The main outcome was OASIS rates. Women without a previous cesarean section and a live singleton fetus in cephalic presentation at term were eligible. The department implemented in 2007 the Finnish concept of active perineal protection, which includes support of perineum, control of fetal expulsion, good communication with the mother and observation of perineal stretching. The practice of mediolateral episiotomy was replaced with lateral episiotomy when indicated. We analyzed the OASIS rates in groups with and without episiotomy stratified for delivery mode, fetal position at delivery and for parity, and adjusted for possible confounders (maternal age, gestational age, oxytocin augmentation and epidural analgesia).
resultsWe observed a long-lasting reduction in OASIS rates from 4.9% to 1.9% and an increase in episiotomy rates from 14.4% to 21.8%. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with instrumental vaginal deliveries and occiput anterior (OA) position; 3.4% vs 10.1% (OR 0.31; 95% CI: 0.24-0.40) and 6.1 vs 13.9% (OR 0.40; 95% CI: 0.19-0.82) in women with occiput posterior (OP) position. Lateral episiotomy was also associated with lower OASIS rates in nulliparous women with spontaneous deliveries and OA position; 2.1% vs 3.2% (OR 0.62; 95% CI: 0.49-0.80). The possible confounders had little confounding effects on the risk of OASIS in groups with and without episiotomy.
conclusionsWe observed a long-lasting reduction in OASIS rates after implementation of preventive procedures. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with an instrumental delivery. Special attention should be paid to deliveries with persistent OP position.
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