Drop in Episiotomy Not Tied to Increase in Obstetric Anal Sphincter Injury for Most Women

FRIDAY, Jan. 17, 2025 (HealthDay News) — A significant overall reduction in the prevalence of episiotomy in France from 2010 to 2021 has not been followed by an overall increase in obstetric anal sphincter injury (OASI), according to a study published online Jan. 14 in PLOS Medicine.

Raphaele Houlbracq, from Université Paris Cité, and colleagues assessed variations in the prevalence of both episiotomy and OASI using data from the 2010, 2016, and 2021 National Perinatal Surveys (29,750 women with a vaginal delivery).

The researchers found that the overall prevalence of episiotomy decreased significantly from 25.8 percent in 2010, to 20.1 percent in 2016, and to 8.3 percent in 2021 (adjusted risk ratio, 0.33). This trend persisted across all groups of the classification, ranging from −33.0 percent in nulliparous women with a term cephalic singleton undergoing forceps delivery to −94.0 percent in those with multiple pregnancy. In an adjusted analysis, the difference in overall prevalence of OASI between 2010 (0.7 percent) and 2021 (1.0 percent) was not statistically significant. Among the classification groups, only nulliparous women with a term cephalic singleton undergoing spatula delivery experienced a significant increase in the prevalence OASI.

“Our results and recent literature suggest that there is a need to reconsider indications of restrictive episiotomy policies for instrumental deliveries in nulliparous women,” the authors write.

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