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Episiotomy

Episiotomy is a surgical incision made in the perineum during childbirth to enlarge the vaginal opening and facilitate delivery.
It is a common obstetric procedure performed to prevent severe perineal tears and assist with difficult deliveries.
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Most cited protocols related to «Episiotomy»

1
Perineal Massage and Postpartum Incontinence: A Pivotal Trial
Information for this study was collected during a randomised controlled trial of perineal massage during the third trimester of pregnancy [4 (link),5 (link)]. The study population consisted of pregnant women with or without a previous vaginal birth delivering in five secondary and tertiary care hospitals in the province of Quebec, Canada. The study was approved by the ethics committees of each participating institution. Women were enrolled at 30 and 35 weeks gestational age. In the intervention group, women were taught to do a stretching massage of the perineum for 5 to 10 minutes daily from 34–35 weeks gestation until delivery; women in the control group were asked to refrain from perineal massage. There were 1527 women enrolled between September 1994 and December 1995. At enrolment, participants completed a questionnaire on socio-demographics and obstetrical history. Women recruited after March 1995 (n = 1198) also completed a self-administered questionnaire on perineal functions during the month before conception and during the month before enrolment (i.e. early third trimester of pregnancy.) The questionnaire elicited information on the frequency (never, less than once per week, 1–6 times a week, once a day, more than once a day) of involuntary loss of urine when coughing, sneezing, laughing, or running. We asked this quantitative question about the frequency of stress incontinence since we were interested in the pathophysiology – actual episodes of urine loss – rather than the social impact of incontinence. At three months postpartum, a questionnaire was mailed to each participant asking about stress urinary incontinence at that point in time. Detailed data on the occurrence and severity of perineal lacerations and episiotomy were recorded immediately after the birth by the attending physician or house staff. The perineum was considered to be intact if there was no laceration or a non-sutured first-degree tear. Other information about the labour and delivery was abstracted from the medical record.
For the analysis of predictors of incontinence, incontinence was treated as dichotomous: any vs. no incontinence. Secondary analyses were carried out restricting the outcome to more severe incontinence – at least weekly and at least daily. To assess urinary incontinence before delivery as a predictor of postpartum incontinence, a categorical variable was constructed with 3 levels: women with incontinence pre-pregnancy (95% continued to be incontinent during pregnancy), new onset of incontinence during pregnancy, and no incontinence before or during this pregnancy. Maternal, obstetrical and new-born candidate variables for the adjusted models were identified by univariate odds ratios (OR) <0.8 or >1.25 in association with urinary incontinence, or from the medical literature. Univariate and adjusted odds ratios (adjOR) and their 95% confidence intervals (95% CI) were obtained. Adjusted odds ratios from logistic regression analysis somewhat overestimate relative risk when the outcome is common. Since episiotomy and operative delivery are determinants ("in the causal pathway") of perineal trauma, separate models were used to analyse whether incontinence was better predicted by these interventions or by the degree of perineal trauma. Univariate, stratified and logistic regression analyses were carried out using Stata 7.0.
Eason E., Labrecque M., Marcoux S, & Mondor M. (2004). Effects of carrying a pregnancy and of method of delivery on urinary incontinence: a prospective cohort study. BMC Pregnancy and Childbirth, 4, 4.
Publication 2004
Childbirth Conception Episiotomy Gestational Age House Staff Infant, Newborn Institutional Ethics Committees Laceration Massage Mothers Obstetric Delivery Perineum Physicians Pregnancy Pregnant Women Teaching Urinary Incontinence Urinary Stress Incontinence Urine Vagina Woman Wounds and Injuries
2
Enriched Sampling of Primiparous Women for LA Tear
This report provides results from ninety primiparous women who were recruited from a university-based, tertiary care teaching hospital using enriched sampling techniques to maximize the probability of women in the study with some degree of any LA tear (Figure 1 portrays the enriched sampling strategy used for a projected enrollment of 100 women (one per month)).
The enriched sampling relied on inclusion criteria of “complex birth factors” heuristically suggestive of LA tear. Because the study began in 2004, we relied on our earlier pilot work [9 (link)] to select women who experienced what we refer to as a “complex vaginal birth.” That is, at least one of the following in their first vaginal delivery: 1) maternal age greater than 33 years, 2) second stage labor greater than 150 minutes, 3) infant weight greater than 4000 gm, 4) forceps, 5) vacuum, 6) third or fourth degree anal sphincter laceration. At the point of data analysis, additional studies in the field had been published so we considered other factors identified as potential complex birth events: episiotomy, larger infant head circumference, length of passive pushing time and use of epidural and oxytocin. Women were excluded from participating if age was less than 18 years, the primary healthcare language was not English, birth occurred before 36 weeks gestation, twin gestation, or an infant admitted to the neonatal intensive care unit.
Low L.K., Zielinski R., Tao Y., Galecki A., Brandon C.J, & Miller J.M. (2014). Predicting Birth-Related Levator Ani Tear Severity in Primiparous Women: Evaluating Maternal Recovery from Labor and Delivery (EMRLD Study). Open journal of obstetrics and gynecology, 4(6), 266-278.
Publication 2014
Childbirth Episiotomy Forceps Head Infant Laceration Obstetric Delivery Obstetric Labor Oxytocin Pregnancy Primary Health Care Sphincters, Anal Twins Vacuum Vagina Woman
3
Reducing Perineal Injuries Through Midwife-Led Interventions
This is a prospective cohort study with an experimental design where an intervention is compared with standard care. The study was conducted at two maternity wards in Stockholm. Maternity ward 1 provides care to approximately 6,500 women/year whereas maternity ward 2 cares for approximately 4,100 women/year. Both wards provide care to women with low‐ and high‐risk pregnancies.
The primary outcome was perineal injuries, classified as second‐degree tears according to international standards 27, in addition using a new Swedish classification where vaginal tears with a measured depth of > 0.5 cm are considered second‐degree tears 28 because of the probability of a fascia defect. Secondary outcomes were the prevalence of no tear at all, severe perineal trauma affecting the anal sphincter complex, episiotomy, and the ability of the midwives in the intervention group to use the intervention.
Second‐degree tears are not registered in the national birth register in Sweden but examination of the local database of births for one of the maternity wards in this project revealed that 77 percent of the primiparous women had a vaginal and/or perineal injury, which is in line with previously reported prevalence 1, 29. A pretrial power calculation based on the assumption that the intervention would reduce second‐degree tears by 15 percent compared with standard care, indicated that at least 242 women were needed in each group to reach a statistical power of 80 percent at a 95 percent significance level (alpha). To ensure that enough participants were recruited to the study and taking dropouts into account, an additional 20 percent generated 291 women in each group.
The study included nulliparous Swedish‐speaking women, gestational age ≥ 37 + 0 weeks with spontaneous onset of labor or induction of labor. Cases of nulliparous women with diabetes mellitus (manifest or pregnancy‐induced), preterm birth ≤ 37 + 0, intrauterine growth restriction, female genital mutilation, multiple pregnancy, fetus in breech presentation, and stillbirths were excluded.
During the study period 1,773 nulliparous women fulfilled the study criteria (Fig. 1). The midwives were asked to write down their reasons for not including women in the study but most often forgot to do so. Reasons given for not asking women to participate were high workload, women not speaking Swedish (exclusion criterion), and failing to remember to ask women to participate.
The intervention is based on a theoretical framework of woman‐centered care 26 which consists of three parts (listed below) and is referred to as the MIMA model of care (an abbreviation for Midwives’ Management during the second stage of labor). The midwives in the intervention group were asked to use all three parts of the intervention during the second stage in all births they attended.

Spontaneous pushing: The woman feels a strong urge to push and follows the urge but does not put on any extra abdominal pressure. The midwife will if needed assist the woman to accomplish a controlled and slow birth of the baby by encouraging breathing and resisting the urge to push during the last contractions 30.

Flexible sacrum positions: Birth positions with flexibility in the sacro‐iliac joints, thereby enabling the pelvic outlet to expand (kneeling, standing, all‐fours, lateral position, and giving birth on the birth seat) 20.

Using the two‐step principle of head‐to‐body birthing technique if possible 18. With this technique, the head is born at the end of a contraction or between contractions and the shoulders are born with the next contraction.

Standard care during the second stage of labor is sparsely recorded by midwives in Sweden and there are no national guidelines about birth position, pushing methods, or whether certain methods of manual perineal protection should be performed. Hence, the management of the second stage of labor depends on the assisting midwife's experience, knowledge, and preferences. The assumption derived from reviewing research and clinical experience is that standard care for primiparous women consists mostly of directed pushing and semi‐recumbent birth positions 17. Furthermore, midwives often prefer to assist the woman to birth the baby's head and shoulders in one contraction because of fear of endangering the child 31.
Edqvist M., Hildingsson I., Mollberg M., Lundgren I, & Lindgren H. (2016). Midwives’ Management during the Second Stage of Labor in Relation to Second‐Degree Tears—An Experimental Study. Birth (Berkeley, Calif.), 44(1), 86-94.
Publication 2016
Abdomen Breech Presentation Child Childbirth Diabetes Mellitus Episiotomy Fascia Fear Feelings Fetal Growth Retardation Gene Order Genetic Testing Gestational Age Head High-Risk Pregnancy Human Body Infant Injuries Labor, Induced Laceration LINE-1 Elements Midwife Mima Obstetric Delivery Obstetric Labor Pelvis Perineum Pregnancy Premature Birth Pressure Sacroiliac Joint Sacrum Shoulder Sphincters, Anal Tears Vagina Woman Wounds and Injuries
4
Perineal Laceration Documentation and Suturing Protocol
A protocol for documentation of perineal lacerations and suturing after vaginal delivery was developed (see Figure S1 in electronic supplementary material). The protocol contains information about perineal trauma as a risk factor for future pelvic floor symptoms, including degree of perineal tear, episiotomy, anterior lacerations and labial lacerations, and specific information regarding suturing of the different lacerations. The protocol was developed to fulfill the needs of a future cohort study of pelvic floor dysfunction in women delivering their first child. The protocol uses the Royal College of Obstetricians and Gynecologists classification of perineal lacerations [8 ], and the distinction between low and high obstetric vaginal laceration is based on the ICD-10 classification [9 ]. Regarding other obstetric vulvar trauma, we used our own clinical experience when developing the questions in the protocol. We aimed to construct a legible protocol configured as a checklist in order to minimize loss of information. A group of midwives and obstetricians at our Department of Obstetrics and Gynecology reviewed the protocol and gave feedback regarding the content and design of the protocol.
All women delivering their first child vaginally from 13 October 2015 to 1 February 2016 at Örebro University Hospital were eligible for the study. The women were included consecutively. The approximate sample size required was estimated based on clinical and scientific experience. No formal power calculation was pursued when planning the study. After delivery the midwife or, where appropriate, the obstetrician in charge documented the perineal laceration and suturing both in the protocol mentioned above and simultaneously in the regular computerized obstetric record system (ObstetriX, Siemens, version 2.14.02.200). In ObstetriX, the midwife documents perineal lacerations and vaginal ruptures in the computerized sheet “Delivery care 1” (Förlossningsvård 1, see Table S1 in electronic supplementary material). In the case of a more extensive perineal tear or vaginal rupture that is sutured by an obstetrician, the obstetrician will document the injury and the suturing in the protocol “Suturing of delivery-related injury” (Sutur av förlossningsskada; see Table S2 in electronic supplementary material). When finishing the documentation regarding a third- or fourth-degree perineal tear, a pop-up window appears with a list and descriptions of the diagnostic codes of third- and fourth-degree perineal tears according to ICD-10, allowing the obstetrician to choose one. The ICD-10 diagnostic codes correspond to the Royal College of Obstetricians and Gynecologists’ classification of perineal tears [8 ]. In the present study, the main author extracted data from the medical record using an accessory program called ObstetriX Delivery Ward Ledger (ObstetriX Förlossningsliggare, version 2.14.02.200, Siemens). To achieve the subclassification of third-degree perineal tears into A, B, and C, the diagnostic code was extracted manually from the medical record.
Jansson M.H., Nilsson K, & Franzén K. (2019). Development and validation of a protocol for documentation of obstetric perineal lacerations. International Urogynecology Journal, 30(12), 2069-2076.
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Publication 2019
Child Delivery of Health Care Diagnosis Episiotomy factor A Gynecologist Injuries Laceration Lip Midwife Obstetric Delivery Obstetrician Pelvic Diaphragm Perineum Tears Vagina Vulva Woman Wounds and Injuries
5
Measuring Childbirth Experience Using Persian CEQ 2.0
Birth experience was measured by the Persian version of the Childbirth Experience Questionnaire version 2.0 (CEQ 2.0) (Additional file 1). The questionnaire consists of 23 questions, 20 of which are scored by likert scale (from 1 to 4 points) and 3 questions using the visual scale (from 0 to 100). Subscales of the CEQ 2.0 include own capacity (questions 1, 2, 4, 5, 6, 7, 21 and 22), professional support (questions 11, 13, 14, 15 and 16), participation (questions 8, 9, 10 and 12) and perceived safety (questions 3, 17, 18, 19, 20, and 23). Negative questions were scored in reverse order. The range of total score and subscales is between 1 and 4, and lower scores represent more traumatic experience. Validity and reliability of the Persian version of CEQ 2.0 has been verified with Cronbach’s alpha of 0.94. The psychometric properties of the Farsi version of the CEQ 2.0 will be reported in another paper. The reliability of the original questionnaire was also high among postpartum women (Cronbach’s alpha = 0.93) [26 (link)]. The traumatic birth experience was considered to be less than a standard deviation from the mean score of the population (mean score ≤ 2.50).
Socio-demographic, pregnancy, labour and birth information were collected using a checklist designed by the research team (Additional file 2). The validity of this checklist was confirmed through face and content validity, so that the questionnaire was distributed to ten experts and after collecting feedback from them, required modifications were made on the questionnaire. The questions included three main categores: a) socio-demographic data (age, education level, occupation, duration of marriage, marital satisfaction, household income, insurance status); b) antenatal data (history of abortion, planned pregnancy, attendance in prenatal classes, first source of support, doing exercise during pregnancy); and intrapartum data (gestational age, place of birth, length of stay in the labour room, permission to move or change position during labour, permission to choose the position of childbirth, augmentation, use of pharmacological or non-pharmaceutical methods to reduce pain, episiotomy, presence of companion and doula). For the purpose of the study, exercising during pregnancy was measured by a question with the response options of Yes or No. We asked about the frequency of any type of exercise in a week and the duration of each exercise. Normal walking and jogging were considered exercise.
Ghanbari-Homayi S., Fardiazar Z., Meedya S., Mohammad-Alizadeh-Charandabi S., Asghari-Jafarabadi M., Mohammadi E, & Mirghafourvand M. (2019). Predictors of traumatic birth experience among a group of Iranian primipara women: a cross sectional study. BMC Pregnancy and Childbirth, 19, 182.
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Publication 2019
Birth Injuries Childbirth Companions Doulas Episiotomy Face Gestational Age Households Pain Pharmaceutical Preparations Postpartum Women Pregnancy Psychometrics Safety Satisfaction

Most recents protocols related to «Episiotomy»

1
Episiotomy Repair Techniques Comparison
This clinical trial study was conducted to 50 pregnant women, aged 18 years or more and who are suitable for normal vaginal delivery, they were enrolled to this study after taking an ethical committee approval in Egypt. A detailed history was taken from all participants, and general examination to exclude the presence of any disorders. Obstetric examinations were performed. Verbal and written consents from all patients are obtained to be recruited in this study.
All relevant information, like the purpose and methodology of the experiment, was explained to study participants beforehand, and informed consent was obtained. All procedures of the present study were conducted in compliance with the Helsinki declaration for research on human beings. The study was approved by the research ethics committee.
Clinical trial number (ClinicalTrials.gov Identifier) is NCT05247073
Active Comparator of this study (Procedure of Mostafa Maged technique: Patients of study group with Mostafa Maged technique for closure of the episiotomy. The vagina will be stitched with the Mostafa Maged technique, The Mostafa Maged four-stitch technique uses absorbable vicryl threads with round needles 75 mm. The technique will prevent dead space formation, Good and tight hemostasis of the episiotomy strong approximation of the two edges of the episiotomy.
Procedure of Mostafa Maged technique:

Mostafa Maged four-stitch technique for closure of the episiotomy.

Identification of the apex of the episiotomy, then a simple suture is taken (0.5 cm) behind the apex of the episiotomy. First, the needle is inserted at the vaginal mucosa (epithelium) of the right edge of the episiotomy then extracts the needle.

The second stitch is inserted on the muscle layer of the same side (right side) of the episiotomy cutting edge then extracting the needle.

Then, insert the needle again on the left side of the episiotomy incision in the muscle layer on the left side of the episiotomy incision directing the tip of the needle upwards parallel to the second stitch taken.

The fourth step is inserting the needle in the vaginal mucosa (epithelium) of the left side parallel to the first stitch. Continue suturing the episiotomy incision continuously in the same way till reaching the remnant of the hymen (fourchette). Then, I make a loop knot at the fourchette. Then, suturing the superficial perineal muscle in a continuous manner and the skin in a subcuticular manner as well. Mostafa Maged technique is illustrated in a model of uterus in Figure (2).

There is a case series of this (Mostafa Maged technique) recently published to reveal this technique (13 ).
Patients of controlled group: The vagina will be stitched using a continuous locking stitch and the perineal muscles and skin are repaired using approximately three or four individual stitches, each needing to be knotted separately to prevent them from dislodging.
Procedure (Patients with routine traditional closure of the episiotomy): patients of controlled group with routine closure of episiotomy
Perineal trauma is traditionally repaired in three stages: a continuous locking stitch is inserted to close the vaginal trauma, commencing at the apex of the wound and finishing at the level of the fourchette with a loop knot. The perineal muscles are then re-approximated with three or four interrupted sutures and finally, the perineal skin is closed by inserting continuous subcutaneous or interrupted transcutaneous stitches.
The skin is then closed with inverted interrupted stitches placed in the subcutaneous tissue a few millimeters under the perineal skin edges (not trans-cutaneously).
While primigravida patients having episiotomies or tears in the vagina and age between 18 to 40 years old were included in the study; whereas, smokers, diabetics, morbidly obese patients, cases with chronic diseases such as renal diseases and cases with 3rd and 4th perineal tears were excluded.
Primary Outcome Measures:Heamostasis of the episiotomy [Time Frame: 4 weeks after delivery] (Bleeding from the epistiomy or heamatoma at the epistomy).
No edema at the site of episiotomy [Time Frame: 4 weeks after delivery] (Swelling or ecchymosis and edema at the edges of episiotomy).
No infection at the episiotomy [Time Frame: 4 weeks after delivery] (Redness, hotness and bad odour of vaginal discharge)
Secondary Outcome Measures:Sexual dysfunction (pain during sexual intercourse) [Time Frame: 4 weeks after delivery] (Pain during sexual intercourse)
Anorectal dysfunction [Time Frame: 4 weeks after delivery] (Inability to control passage of stool or flatus or both).
Statistical analysis: Data collection and coding were performed to enable data manipulation as well as double entered into Microsoft Access, and the analysis was done utilizing version 22 of the Statistical Package of Social Science (SPSS) (SPSS Inc., Chicago, IL, USA). In addition, a simple descriptive analysis was performed using percentages and numbers of qualitative data, standard deviations for the dispersion of quantitative parametric data, as well as arithmetic means as central tendency measurement.
For quantitative data: Independent samples t-test was utilized for comparing quantitative measures between two independent groups.
For qualitative data: The Chi-square test was utilized for comparing two of more than two qualitative groups. The p-value< 0.05 was considered statistically significant.
, & Ali M.M. (2023). The Effectiveness of Mostafa Maged Technique in Closure of the Episiotomy during Vaginal Delivery. Ethiopian Journal of Health Sciences, 33(1), 49-54.
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Publication 2023
A-Loop Bladder Detrusor Muscle Coitus Disease, Chronic Ecchymosis Edema Episiotomy Epithelium Erythema Ethics Committees, Research Feces Flatulence Hemostasis Homo sapiens Hot Temperature Hymen Infection Kidney Diseases Mucous Membrane Muscle Tissue Myotomy Needles Obesity Obstetric Delivery Odors Pain Patients Perineum Physical Examination Pregnant Women Reading Frames Skin Subcutaneous Tissue Surgical Closure Techniques Sutures Tears Uterus Vagina Vicryl Wounds Wounds and Injuries
2
Measuring Obstetric Violence During Childbirth

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Publication 2023
Abuse, Emotional Acceptance and Commitment Therapy Childbirth Drug Abuse Episiotomy Mothers Patient Discharge Pets Physical Examination Pressure Speech Woman
3
Postpartum Anal and Urinary Continence Assessment
The analysis of anal continence was based on the Vaizey score [22 (link)] (Appendix A). Data differs in the literature to assess which Vaizey value significantly defines incontinence [23 (link)]. In the EPIC study, based on this literature and on expert opinion, a score ≥5 defined AI [8 (link),24 (link)]. Our population being inhomogeneous regarding continence before D2, we selected as the primary endpoint worsening of the Vaizey score after D2, defined as an increase ≥2 points in the score between the two proctological examinations. Comparable definitions were used in previous proctologic studies [25 (link)].
Because transient AI (lasting less than 2 months) is common in the immediate postpartum period [26 (link),27 (link)], the assessment 6 months after D2 was used to measure persistent continence deterioration.
EAS was performed by a single trained operator, using a rotating rectal probe (7–10 MHz, Brüel and Kjaer). Upper, middle and lower anal canal were studied. A sphincter lesion was identified as a loss of continuity visible by a change in echogenicity within the sphincter ring [28 (link)]. Severity was assessed based on the Starck score (Appendix B). A score ≥9 was used to define a severe sphincter rupture [29 (link),30 (link)]. The clinical description of perineal lesions was based on the Royal College of Obstetricians and Gynecologists classification, where the anal sphincter is considered impaired in grades III and IV (Appendix C). We defined a “hidden sphincter rupture” as a tear undiagnosed in the delivery room (or under-diagnosed as a grade I or II) but observed by EAS. After D2, ruptures were considered “de novo” if no EAS defect was visible after D1.
The analysis of urinary continence was based on the MHU score (Appendix D) [31 (link)], treated as a continuous variable ranging from 0 to 28 points. Macrosomia was defined by birthweight >4 kg [32 (link)]. Birthweight was not collected in D2 in the case of CS. Instrumental delivery referred to the use of all types of forceps or vacuum but the type of forceps was not specified. Details of the episiotomy were not collected. We defined “abnormal transit” as the presence of diarrhea, constipation or dyschesia. We asked the patients whether or not they had undergone perineal rehabilitation, but the modalities were not collected (number of sessions or technique used).
Marcellier G., Dupont A., Bourgeois-Moine A., Le Tohic A., De Carne-Carnavalet C., Poujade O., Girard G., Benbara A., Mandelbrot L, & Abramowitz L. (2023). Risk Factors for Anal Continence Impairment Following a Second Delivery after a First Traumatic Delivery: A Prospective Cohort Study. Journal of Clinical Medicine, 12(4), 1531.
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Publication 2023
Anal Canal Anus Birth Weight Constipation Diarrhea Dyschezia Episiotomy Forceps Gynecologist Laceration Obstetric Delivery Obstetrician Patients Perineum Physical Examination Rectum Rehabilitation Sphincters, Anal Transients Urinalysis Vacuum
4
Episiotomy Effects on Subsequent Birth
We identified 323 748 women who gave birth to a first and second child during the study period 2000–2014. Both births were restricted to live born, single neonates, born in cephalic presentation at gestational week 34 or later, without malformations (excluding all ICD‐10 Q‐diagnoses) in order to exclude common indications for prelabor cesarean delivery such as multiple pregnancy, breech presentation and malformation. To achieve a sample of women with a first birth with VE, we excluded women with spontaneous vaginal delivery, cesarean delivery, forceps delivery or combined instrumental delivery in the first birth. In total, 45 674 (14.1%) women had a first birth with VE (Figure 1).
The exposure lateral or mediolateral episiotomy was defined by a checkbox in the standardized maternal medical record marking a left‐ or right‐sided episiotomy. In total, 13 950 (31.2%) women had a lateral or mediolateral episiotomy and 30 706 (68.8%) had no episiotomy. Women with a midline (n = 209, 0.5%) or undefined type of episiotomy (with the procedure code TMA00 but no indication of side, n = 809, 1.8%) were excluded. The final cohort included 44 656 women with a lateral/mediolateral episiotomy or no episiotomy (Figure 1).
Brismar Wendel S., Liu C, & Stephansson O. (2023). The association between episiotomy or OASIS at vacuum extraction in nulliparous women and subsequent prelabor cesarean delivery: A nationwide observational study. Acta Obstetricia et Gynecologica Scandinavica, 102(3), 378-388.
Publication 2023
Breech Presentation Cesarean Section Child Childbirth Congenital Abnormality Diagnosis Episiotomy Forceps Infant, Newborn Obstetric Delivery Pregnancy Vagina Woman
5
Episiotomy and Prelabor Cesarean Delivery
Analyses were performed in SPSS 26.0 (IBM Corp, Armonk, NY, USA). Firstly we constructed a directed acyclic graph to establish possible confounders and mediators (Figure S1). Then we explored differences between women exposed to episiotomy or not in the first birth by VE using test of proportions, based on the directed acyclic graph. We considered differences with a p‐value of <0.10 as possible confounders since these covariates had a 90% likelihood or more of being associated with the outcome (Table 1). Factors analyzed but omitted from Table 1 due to nonsignificant differences were smoking, cohabitation, hypertension and preeclampsia (data not presented).
Secondly, we assessed risk factors for prelabor cesarean delivery in the second birth using covariates from Table 1 in univariate and multivariate regression models. Results are presented as crude and adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) in Table 2. The multivariate model included all factors significant in the univariate analysis: maternal age, country of birth, education, gestational age, epidural, labor dystocia, intrapartum fetal distress, station, head position, head circumference, birthweight, shoulder dystocia, Apgar 1 min <4, Apgar 1 min <7, episiotomy, year of delivery and region of delivery.
Thirdly, the propensity score (the conditional probability of being assigned episiotomy or not) was calculated using all covariates with a p‐value of <0.10 in Table 1: maternal age, country of birth, maternal height, maternal BMI, higher education, gestational age, epidural, labor dystocia, intrapartum fetal distress, fetal station, head position, head circumference, birthweight, shoulder dystocia, Apgar 1 min <4, Apgar 1 min <7, year of delivery and region of delivery. The propensity score was then used to perform a regression analysis and to calculate an inversed probability of treatment (episiotomy) weight for each individual as initially described by Rosenbaum.18 We used a modified computer syntax for SPSS provided by Thoemmes et al.19 The weight was used to account for bias due to observed confounders creating a pseudo‐population in which the covariates and the treatment assignment (episiotomy or not) are independent of each other, to mimic a randomized treatment assignment.20, 21, 22 We assessed the outcome using all obtained stabilized weights, as well as truncated stabilized weights, at the 5th and 95th percentiles or the 1st and 99th percentiles.
Fourthly, since episiotomy and OASIS are associated, we explored the prevalence and association of prelabor cesarean delivery in the second birth in women with four principal groups of exposure: “neither episiotomy nor OASIS”, “episiotomy, no OASIS”, “OASIS, no episiotomy” and “both OASIS and episiotomy”, using “neither episiotomy nor OASIS” as reference. The association was tested using multivariate logistic regression adjusting for maternal age, country of birth, higher education, gestational age, epidural, labor dystocia, intrapartum fetal distress, station, head position, head circumference, birthweight, shoulder dystocia, Apgar at 1 min, year of delivery, and region of delivery. Moreover, interaction between episiotomy and OASIS was formally tested using multivariate logistic regression entering the interaction term “episiotomy*OASIS”, “episiotomy”, “OASIS”, and all the confounders used in the multivariate model.
Brismar Wendel S., Liu C, & Stephansson O. (2023). The association between episiotomy or OASIS at vacuum extraction in nulliparous women and subsequent prelabor cesarean delivery: A nationwide observational study. Acta Obstetricia et Gynecologica Scandinavica, 102(3), 378-388.
Publication 2023
Birth Birth Weight Care, Prenatal Cesarean Section CREB3L1 protein, human Dystocia Episiotomy Fetal Distress Gestational Age Head High Blood Pressures Mothers Obstetric Delivery Pre-Eclampsia Shoulder Dystocia Woman

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STATA software version 13 is a comprehensive, integrated statistical software package that provides data management, statistical analysis, graphics, simulations, programming, and reporting capabilities. It is designed for research professionals and data analysts to perform a wide range of statistical analyses and data management tasks.
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Spss 20 by IBM
Sourced in United States, United Kingdom, Germany, Japan, Denmark, China, Belgium, Poland, Austria, Australia
SPSS 20.0 is a statistical software package developed by IBM for data analysis, data management, and data visualization. It provides a wide range of statistical techniques, including descriptive statistics, bivariate statistics, prediction for numerical outcomes, and prediction for identifying groups. SPSS 20.0 is designed to help users analyze and understand data quickly and efficiently.
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Spss version 20 by IBM
Sourced in United States, Japan, United Kingdom, Germany, Belgium, Austria, Spain, France, Denmark, Switzerland, Ireland
SPSS version 20 is a statistical software package developed by IBM. It provides a range of data analysis and management tools. The core function of SPSS version 20 is to assist users in conducting statistical analysis on data.
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Spss version 24 by IBM
Sourced in United States, Japan, United Kingdom, Germany, Belgium, Austria, China, Spain, Ireland
SPSS version 24 is a statistical software package developed by IBM. It provides a comprehensive set of tools for data analysis, including techniques for descriptive statistics, regression analysis, and predictive modeling. The software is designed to help users interpret data, identify trends, and make informed decisions based on statistical insights.

More about "Episiotomy"

Episiotomy is a common obstetric procedure performed during childbirth to enlarge the vaginal opening and facilitate delivery.
It involves making a surgical incision in the perineum, the area between the vagina and rectum, to prevent severe perineal tears and assist with difficult deliveries.
This procedure is often necessary when the baby's head is too large to pass through the birth canal easily or when the mother is experiencing a prolonged or complicated labor.
Episiotomies can help reduce the risk of more extensive tearing and potentially speed up the delivery process.
Researchers studying episiotomies may utilize various statistical software packages, such as SAS 9.4, SPSS, and STATA, to analyze data and optimize their research protocols.
These tools can help researchers compare published literature, preprints, and patents related to episiotomy procedures, enhancing the reproducibility and accuracy of their findings.
PubCompare.ai is a powerful AI-driven platform that can assist researchers in their episiotomy studies by providing comprehensive comparisons of relevant research materials.
This helps researchers make informed decisions and improve the quality of their work, ultimately leading to better patient outcomes.
When conducting episiotomy research, it's important to consider related terms and concepts, such as perineal tears, vaginal deliveries, and obstetric interventions.
Abbreviations like 'BACTEC' (a blood culture system) may also be relevant, depending on the specific focus of the study.
By incorporating these insights and leveraging the capabilities of advanced software tools, researchers can optimJze their episiotomy studies and contribute to the ongoing efforts to improve maternal and neonatal health outcomes.