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dc.contributor.authorEggebø, Torbjørn Moe
dc.contributor.authorRygh, Astrid
dc.contributor.authorvon Brandis, Philip
dc.contributor.authorSkjeldestad, Finn Egil
dc.date.accessioned2024-08-21T11:56:49Z
dc.date.available2024-08-21T11:56:49Z
dc.date.issued2023-12-05
dc.description.abstractIntroduction - There 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.<p> <p>Material and methods - We 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).<p> <p>Results - We 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.<p> <p>Conclusions - We 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.en_US
dc.identifier.citationEggebø TM, Rygh AB, von Brandis P, Skjeldestad FE. Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study. Acta Obstetricia et Gynecologica Scandinavica. 2024;103(3):488-497en_US
dc.identifier.cristinIDFRIDAID 2282157
dc.identifier.doi10.1111/aogs.14742
dc.identifier.issn0001-6349
dc.identifier.issn1600-0412
dc.identifier.urihttps://hdl.handle.net/10037/34319
dc.language.isoengen_US
dc.publisherWileyen_US
dc.relation.journalActa Obstetricia et Gynecologica Scandinavica
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2024 The Author(s)en_US
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0en_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)en_US
dc.titlePrevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort studyen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)