Episiotomy type linked to differing anal sphincter injury risk in operative delivery

A secondary analysis of the MFMU APEX cohort examined the association between episiotomy and obstetric anal sphincter injury (third- or fourth-degree lacerations) among 5,277 patients undergoing operative vaginal delivery. The study reported that episiotomy overall was associated with higher odds of sphincter injury, but effects varied by type and delivery history: mediolateral episiotomy was associated with lower odds of injury in patients without a prior vaginal delivery, while midline episiotomy was associated with higher odds of injury during vacuum-assisted delivery regardless of vaginal delivery history. The authors state these findings are consistent with prior studies and suggest further investigation is warranted to identify patients who might derive benefit from mediolateral episiotomy before operative vaginal delivery.

Most relevant for: Patients undergoing vacuum- or forceps-assisted vaginal delivery, particularly those without a prior vaginal delivery.

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