TITLE:
Impact of Selective vs Routine Midline Episiotomy and Lacerations of the Anal Sphincter
AUTHORS:
Samanta Schneider, Amanda Vilaverde Perez, Nadine Morais da Silva, Charles Francisco Ferreira, Fernanda Santos Grossi, Mariana Sbaraini, Sérgio H. Martins-Costa, Janete Vettorazzi, Edimárlei Gonsales Valério
KEYWORDS:
Restrictive Episiotomy; Third-Degree Perineal Laceration, Fourth-Degree Perineal Laceration, Obstetric Anal Sphincter Tear
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.6,
June
11,
2019
ABSTRACT: Introduction: Obstetric anal sphincter tear (OAST) is associated with anal
incontinence. Episiotomy was proposed as a form of protection of the anal
sphincter at delivery; however, several studies have shown that routine use of
episiotomy does not reduce the risk of OAST. Objective: This study aims
to analyse whether the reduction in the
rate of episiotomy in a school hospital in Brazil was associated with an
increase in the incidence of obstetric lacerations of the anal sphincter, in
addition to associated factors. Methods: Observational, cross-sectional
and retrospective study. We included all vaginal deliveries of single
pregnancies, cephalic presentation, from 34 weeks of gestational age, performed
in 2011-2012 (liberal episiotomy) and 2015-2016 (restricted episiotomy), and
compared in relation to the rate of mediolateral episiotomy and OAST. Results:
4268 births were analysed (2043 in
2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to
44.2% (p ≤ 0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations
in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations
in 2225 births (1.39%). There was interaction when comparing the two periods in
relation to the episiotomy and the occurrence of OAST (p ≤ 0.0001).
Factors associated with OAST were labor induction and shoulder dystocia. Conclusion:
There was an increase in the rate of lacerations of the anal sphincter with use of restrictive episiotomy. However, this
increase occurred both in deliveries with and in deliveries without episiotomy.