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International Urogynecology Journal
Published in: International Urogynecology Journal 6/2022

12-01-2022 | Episiotomy | Original Article

Association between second stage of labour length and risk of obstetrical anal sphincter injury in nulliparous women: a population-based retrospective cohort study

Authors: Jocelyn Stairs, Mary Margaret Brown, Anita Smith, Christy Woolcott

Published in: International Urogynecology Journal | Issue 6/2022

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Abstract

Introduction and hypothesis

Obstetrical anal sphincter injury (OASIS) is a common consequence of vaginal delivery in nulliparas and carries the risk of short- and long-term morbidity. The objective of this study was to estimate the association between the duration of the second stage of labour and OASIS risk.

Methods

A population-based, retrospective cohort of nulliparas delivering singleton, vertex, non-anomalous fetuses at term in Nova Scotia, Canada, from 2005 to 2019, were identified using the Nova Scotia Atlee Perinatal Database. Poisson regression models were used to estimate risk ratios (RR) with robust 95% confidence intervals (CI) adjusting for confounding variables to investigate the association between the length of the second stage and OASIS in the entire cohort and in operative vaginal deliveries.

Results

Of 36,662 participants, 7.6% sustained an OASIS (6.8% third-degree, 0.8% fourth-degree tear). The proportion of participants who sustained an OASIS increased over the study period. For each 30-min increase in the length of second stage, the OASIS risk increased by 11% (RR 1.11, 95% CI 1.10–1.12). When stratified by mode of delivery, second stage length ≥ 90 min was associated with an increased OASIS risk in spontaneous (RR 1.35, 95% CI 1.15–1.58) and vacuum-assisted vaginal deliveries (RR 1.42, 95% CI 1.11–1.81). In forceps-assisted vaginal deliveries, OASIS risk was increased, with shorter and longer durations of the second stage.

Conclusion

Increasing length of the second stage of labour was associated with increasing risk of OASIS overall, but the association was heterogeneous between modes of delivery. Length of the second stage should be considered in counseling about OASIS risk.
Appendix
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Metadata
Title
Association between second stage of labour length and risk of obstetrical anal sphincter injury in nulliparous women: a population-based retrospective cohort study
Authors
Jocelyn Stairs
Mary Margaret Brown
Anita Smith
Christy Woolcott
Publication date
12-01-2022
Publisher
Springer International Publishing
Keyword
Episiotomy
Published in
International Urogynecology Journal / Issue 6/2022
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-021-05070-9

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