Risk factors for the recurrence of obstetrical anal sphincter injury and the role of a mediolateral episiotomy: an analysis of a national registry.

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  • Additional Information
    • Affiliation:
      Department of Obstetrics and Gynaecology, Amphia Hospital Breda, Breda, the Netherlands
      Department of Medical Informatics, Academic Medical Centre, Amsterdam, the Netherlands
      Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
      Department of Obstetrics and Gynaecology, Monash University, Clayton Victoria,, Australia
      Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands
      Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Objective: The assessment of risk factors, including mediolateral episiotomy (MLE), for the recurrence of obstetric anal sphincter injury (rOASI).Design: Population-based cohort study.Setting: Data from the nationwide database of the Dutch Perinatal Registry (Perined).Population: A cohort of 391 026 women at term, of whom 9943 had an OASI in their first delivery and had a second vaginal delivery of a liveborn infant in cephalic position.Methods: Possible risk factors were tested for statistical significance using univariate and multivariate logistic regression analysis.Main Outcome Measures: Rate of rOASI.Results: The rate of rOASI was 5.8%. Multivariate analysis identified a birthweight of ≥4000 g (adjusted OR, aOR, 2.1, 95% CI 1.6-2.6) and a duration of second stage of ≥30 minutes (aOR 1.8, 95% CI 1.4-2.3) as statistically significant risk factors for rOASI. Mediolateral episiotomy was associated with a statistically significant lower rate of rOASI in spontaneous vaginal delivery (SVD) (aOR 0.4, 95% CI 0.3-0.5) and in operative vaginal delivery (OVD) (aOR 0.2, 95% CI 0.1-0.5).Conclusions: Women with a history of OASI have a higher rate of OASI in their next delivery. Duration of the second stage of ≥30 minutes and a birthweight of ≥4000 g are significantly associated with an increased rate of rOASI. Mediolateral episiotomy is associated with a significantly lower rate of rOASI in both SVD and OVD.Tweetable Abstract: Mediolateral episiotomy is associated with a significant lower recurrence rate of OASI in women with an OASI in their first delivery.
    • Journal Subset:
      Biomedical; Europe; Peer Reviewed; UK & Ireland
    • Instrumentation:
      Infant Characteristics Questionnaire (ICQ) (Bates et al)
    • ISSN:
      1470-0328
    • MEDLINE Info:
      PMID: NLM32285571 NLM UID: 100935741
    • Publication Date:
      20200619
    • Publication Date:
      20200702
    • DOI:
      10.1111/1471-0528.16263
    • Accession Number:
      143745991
  • Citations
    • ABNT:
      BAVEL, J. et al. Risk factors for the recurrence of obstetrical anal sphincter injury and the role of a mediolateral episiotomy: an analysis of a national registry. BJOG: An International Journal of Obstetrics & Gynaecology, [s. l.], v. 127, n. 8, p. 951–956, 2020. DOI 10.1111/1471-0528.16263. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=143745991. Acesso em: 28 set. 2020.
    • AMA:
      Bavel J, Ravelli A, Abu HA, et al. Risk factors for the recurrence of obstetrical anal sphincter injury and the role of a mediolateral episiotomy: an analysis of a national registry. BJOG: An International Journal of Obstetrics & Gynaecology. 2020;127(8):951-956. doi:10.1111/1471-0528.16263
    • APA:
      Bavel, J., Ravelli, A., Abu, H. A., Roovers, J., Mol, B., Leeuw, J., van Bavel, J., Abu-Hanna, A., Mol, B. W., & de Leeuw, J. W. (2020). Risk factors for the recurrence of obstetrical anal sphincter injury and the role of a mediolateral episiotomy: an analysis of a national registry. BJOG: An International Journal of Obstetrics & Gynaecology, 127(8), 951–956. https://doi.org/10.1111/1471-0528.16263
    • Chicago/Turabian: Author-Date:
      Bavel, J, ACJ Ravelli, Hanna, A Abu, JPWR Roovers, BW Mol, JW Leeuw, J van Bavel, A Abu-Hanna, B W Mol, and J W de Leeuw. 2020. “Risk Factors for the Recurrence of Obstetrical Anal Sphincter Injury and the Role of a Mediolateral Episiotomy: An Analysis of a National Registry.” BJOG: An International Journal of Obstetrics & Gynaecology 127 (8): 951–56. doi:10.1111/1471-0528.16263.
    • Harvard:
      Bavel, J. et al. (2020) ‘Risk factors for the recurrence of obstetrical anal sphincter injury and the role of a mediolateral episiotomy: an analysis of a national registry’, BJOG: An International Journal of Obstetrics & Gynaecology, 127(8), pp. 951–956. doi: 10.1111/1471-0528.16263.
    • Harvard: Australian:
      Bavel, J, Ravelli, A, Abu, HA, Roovers, J, Mol, B, Leeuw, J, van Bavel, J, Abu-Hanna, A, Mol, BW & de Leeuw, JW 2020, ‘Risk factors for the recurrence of obstetrical anal sphincter injury and the role of a mediolateral episiotomy: an analysis of a national registry’, BJOG: An International Journal of Obstetrics & Gynaecology, vol. 127, no. 8, pp. 951–956, viewed 28 September 2020, .
    • MLA:
      Bavel, J., et al. “Risk Factors for the Recurrence of Obstetrical Anal Sphincter Injury and the Role of a Mediolateral Episiotomy: An Analysis of a National Registry.” BJOG: An International Journal of Obstetrics & Gynaecology, vol. 127, no. 8, July 2020, pp. 951–956. EBSCOhost, doi:10.1111/1471-0528.16263.
    • Chicago/Turabian: Humanities:
      Bavel, J, ACJ Ravelli, Hanna, A Abu, JPWR Roovers, BW Mol, JW Leeuw, J van Bavel, A Abu-Hanna, B W Mol, and J W de Leeuw. “Risk Factors for the Recurrence of Obstetrical Anal Sphincter Injury and the Role of a Mediolateral Episiotomy: An Analysis of a National Registry.” BJOG: An International Journal of Obstetrics & Gynaecology 127, no. 8 (July 2020): 951–56. doi:10.1111/1471-0528.16263.
    • Vancouver/ICMJE:
      Bavel J, Ravelli A, Abu HA, Roovers J, Mol B, Leeuw J, et al. Risk factors for the recurrence of obstetrical anal sphincter injury and the role of a mediolateral episiotomy: an analysis of a national registry. BJOG: An International Journal of Obstetrics & Gynaecology [Internet]. 2020 Jul [cited 2020 Sep 28];127(8):951–6. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=143745991