Questionable Benefit for Episiotomy in Vacuum Delivery
(HealthDay News) — Episiotomy is associated with obstetric anal sphincter injuries (OASIS) during vacuum delivery, with risk varying based on parity and type of episiotomy, according to a meta-analysis published in the July issue of BJOG: An International Journal of Obstetrics and Gynaecology.
Lena Sagi-Dain, MD, from the Carmel Medical Center, and Shlomi Sagi, MD, from the Bnai Zion Medical Center – both in Haifa, Israel, conducted a systematic review and meta-analysis to examine the role of episiotomy on outcomes during vacuum deliveries. Fifteen articles were reviewed, with data for 350,764 vacuum deliveries.
The researchers found that in nulliparous women there was a nonsignificant correlation between mediolateral episiotomy and OASIS (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.43–1.07), while an increased risk was seen in parous women (OR, 1.27; 95% CI, 1.05–1.53). In nulliparous and parous women, there was a significantly higher risk of OASIS with median episiotomy use (ORs, 5.11 and 89.4, respectively). In nulliparous women, lateral episiotomy correlated with significantly lower OASIS risk (OR, 0.59). Increased rates of postpartum hemorrhage and analgesia use were seen in association with mediolateral episiotomy (ORs, 1.82 and 2.10, respectively).
"Mediolateral and median episiotomy in parous woman may increase the rate of OASIS at vacuum delivery, whereas lateral episiotomy in nulliparous women could be associated with a decreased risk of OASIS," the authors write.