Hong Kong medical journal = Xianggang yi xue za zhi · 2026
A ten-year evaluation of the incidence of obstetric anal sphincter injury with a reduced episiotomy rate.
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Lau Y Y, Chau T W, Tang W C, Cheung R Y K, Ng S M, Tso T M, Chan S S C
Аннотация
INTRODUCTION: The role of episiotomy in preventing obstetric anal sphincter injury (OASIS) remains controversial. Liberal use of episiotomy has been reduced locally. This study aimed to review the incidence of OASIS in our unit over the past decade given the reduced episiotomy rate.
METHODS: A retrospective study was conducted in a single tertiary obstetrics and gynaecology unit. All singleton vaginal deliveries, including normal and instrumental deliveries, between 2012 and 2021 were included. Data were retrieved from the hospital electronic delivery database between July 2022 and June 2023. The degree of OASIS was assessed using the Abdul Sultan classification.
RESULTS: In total, 43 732 deliveries were included. The episiotomy rate decreased from 62.8% in 2012 to 44.7% in 2021 (P<0.001), while the OASIS rate increased from 0.3% to 1.4% over the same period (P<0.001). Among nulliparous women, the OASIS rate was significantly lower with episiotomy in both normal vaginal deliveries (0.6% vs 1.7%; P<0.001) and instrumental deliveries with episiotomy than without (1.7% vs 42.9%; P<0.001). Among multiparous women, the OASIS rate was significantly lower in normal vaginal delivery without episiotomy than with (0.3% vs 0.5%; P=0.026), but significantly lower in instrumental deliveries with episiotomy than without (0.5% vs 23.5% P<0.001). Overall, episiotomy was a protective factor for OASIS (odds ratio=0.273, 95% confidence interval= 0.208-0.358; P<0.001).
CONCLUSION: Episiotomy was protective against OASIS among nulliparous women with singleton normal vaginal delivery and instrumental delivery in an Asian population. It also conferred protection among multiparous women undergoing instrumental delivery but not in those having normal vaginal delivery.
METHODS: A retrospective study was conducted in a single tertiary obstetrics and gynaecology unit. All singleton vaginal deliveries, including normal and instrumental deliveries, between 2012 and 2021 were included. Data were retrieved from the hospital electronic delivery database between July 2022 and June 2023. The degree of OASIS was assessed using the Abdul Sultan classification.
RESULTS: In total, 43 732 deliveries were included. The episiotomy rate decreased from 62.8% in 2012 to 44.7% in 2021 (P<0.001), while the OASIS rate increased from 0.3% to 1.4% over the same period (P<0.001). Among nulliparous women, the OASIS rate was significantly lower with episiotomy in both normal vaginal deliveries (0.6% vs 1.7%; P<0.001) and instrumental deliveries with episiotomy than without (1.7% vs 42.9%; P<0.001). Among multiparous women, the OASIS rate was significantly lower in normal vaginal delivery without episiotomy than with (0.3% vs 0.5%; P=0.026), but significantly lower in instrumental deliveries with episiotomy than without (0.5% vs 23.5% P<0.001). Overall, episiotomy was a protective factor for OASIS (odds ratio=0.273, 95% confidence interval= 0.208-0.358; P<0.001).
CONCLUSION: Episiotomy was protective against OASIS among nulliparous women with singleton normal vaginal delivery and instrumental delivery in an Asian population. It also conferred protection among multiparous women undergoing instrumental delivery but not in those having normal vaginal delivery.