Variation in Episiotomy Use Among Nulliparous Individuals by Maternity Care Provider and Associated Rates of Obstetric Anal Sphincter Injury.
J Obstet Gynaecol Can
; 46(5): 102415, 2024 May.
Article
in En
| MEDLINE
| ID: mdl-38387834
ABSTRACT
OBJECTIVES:
To quantify variation in the association between episiotomy and obstetric anal sphincter injury (OASI) by maternity care provider in spontaneous and operative vaginal deliveries (SVDs and OVDs).METHODS:
Population-based retrospective cohort study of vaginal, term deliveries among nullipara in Canada (2004-2015). Adjusted rate ratios (ARRs) and 95% CIs were estimated using log-binomial regression to quantify the associations between episiotomy and OASI, stratified by care provider (obstetrician [OB], family physician [FP], or registered midwife [RM]) while adjusting for potential confounders.RESULTS:
The study included 631 642 deliveries. Episiotomy use varied by provider among SVDs, the episiotomy rate was 19.6%, 14.4%, and 8.4% in the OB, FP, and RM groups, respectively. The rate of OASI was higher among SVDs with versus without episiotomy (5.8% vs 4.6%). Conversely, OASI occurred less frequently in operative vaginal deliveries with episiotomy (15.3%) compared with those without (16.7%). In all provider groups, the ARR for OASI was increased with episiotomy in SVD and decreased with episiotomy with forceps delivery. No differences in these associations were observed by provider except among vacuum delivery (ARR with episiotomy vs. without, OB 0.88, 95% CI 0.84-0.92; FP 0.89, 95% CI 0.83-0.96, RM 1.22, 95% CI 1.02-1.48).CONCLUSIONS:
In nullipara, irrespective of maternity care provider, there is a positive association between episiotomy and OASI among SVDs and an inverse association between episiotomy and deliveries with forceps. The relationship between episiotomy and OASI is modified by maternity care providers among vacuum deliveries.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Anal Canal
/
Parity
/
Episiotomy
Limits:
Adult
/
Female
/
Humans
/
Pregnancy
Country/Region as subject:
America do norte
Language:
En
Journal:
J Obstet Gynaecol Can
Journal subject:
GINECOLOGIA
/
OBSTETRICIA
Year:
2024
Document type:
Article