ArticleInternational journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics2026
The association between epidural analgesia and perineal injury in primiparous women: A propensity score-matched cohort study.
Article in International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- The impact of advanced maternal age on the risk of perineal and anal sphincter injuries in nulliparous women.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Inflammatory bowel disease and risk of perineal injury in primiparous vaginal births: a retrospective cohort study.Inflammatory bowel diseases · 2026Article
- Clinical predictors of postpartum vaginal and vulvar hematomas and the need for surgical treatment.Pregnancy (Hoboken, N.J.) · 2026Article
- Impact of gestational weight gain on perineal injury and obstetric anal sphincter injury among underweight primiparous women.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Impact of gestational weight gain on perineal injury in overweight and obese primiparous women.Archives of gynecology and obstetrics · 2026Article
- Association of labor epidural analgesia with early postpartum pelvic floor function in primiparous women undergoing vaginal delivery: a retrospective cohort study.Frontiers in surgery · 2026Article
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7 authors.
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Abstract
objectiveTo determine the association between epidural analgesia and perineal injury, including obstetric anal sphincter injury (OASI), in primiparous women.
methodsWe conducted a retrospective cohort study of primiparous women with singleton, term, vertex, and vaginal deliveries between 2012 and 2024 at a tertiary medical center. Primary outcomes were (1) any perineal injury, and (2) OASI. Propensity score matching (1:1) was used to adjust for maternal and obstetric confounders. Perineal outcomes were compared in matched and unmatched cohorts using standardized mean difference (SMD). An SMD <0.1 was considered negligible, 0.1-0.2 small, and >0.2 clinically significant. Multivariable logistic regression was used to evaluate associations between epidural use and outcomes.
resultsOverall, 45 132 women were included, of whom 36 799 (81.5%) received epidural analgesia. After matching (n = 5974 per group), baseline characteristics were balanced apart from fetal head station at full dilation, which was higher in the no-epidural group (0.90 ± 0.9 vs. 0.66 ± 0.8; SMD = 0.239). Perineal injury occurred more often with epidural with a marginal difference (82.2% vs. 78.2%, SMD = 0.10). In a multivariable logistic regression analysis, epidural was associated with more perineal injury only in the absence of episiotomy (adjusted odds ratio [aOR] 1.321; 95% confidence interval [CI]: 1.225-1.425; P < 0.001), but not when episiotomy was performed. Conversely, epidural use was associated with lower OASI risk regardless of whether episiotomy was performed (aOR 0.492; 95% CI: 0.285-0.849; P = 0.011) or not (aOR 0.592; 95% CI: 0.424-0.825; P = 0.002).
conclusionIn primiparous term vaginal deliveries, epidural analgesia modestly increased low-grade perineal tears but reduced OASI risk, supporting its safety regarding severe perineal trauma.
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