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International Urogynecology Journal

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01-11-2020 | Episiotomy | Original Article

Sonographic fetal head circumference and the risk of obstetric anal sphincter injury following vaginal delivery

Authors: Raanan Meyer, Amihai Rottenstreich, Michal Zamir, Hadas Ilan, Edward Ram, Menachem Alcalay, Gabriel Levin

Published in: International Urogynecology Journal | Issue 11/2020

Abstract

Introduction

High birth weight is strongly associated with OASIS; nevertheless, it has not been determined which biometric characteristics most affect OASIS occurrence. We aimed to evaluate the association of estimated fetal head circumference with OASIS occurrence among primiparous women delivering by unassisted vaginal delivery.

Methods

A retrospective study included all primiparous women who delivered at term by spontaneous vaginal delivery from 2011–2019. Women were allocated to two groups: (1) those who experienced OASIS and (2) those who did not experience OASIS. Risk factors for OASIS were analyzed.

Results

Overall, 7646 women were included in the study cohort. Of those, 119/7646 (1.6%; 95% CI, 1.3–1.9%) experienced OASIS. Sonographic head circumference and birth weight did not vary between groups. Prolonged second stage was more common in the OASIS group [23 (19%) vs. 986 (13.3%), 1.58 OR (95% CI 1.003–2.51, p = 0.04)]. Absence of epidural analgesia was more common in the OASIS group [30 (25%) vs. 1197 (15.9%), 1.8 OR (95% CI 1.1–2.7, p = 0.006)]. On multivariate logistic regression analysis, the lack of epidural analgesia and duration of second stage of labor were both independently positively associated with OASIS [adjusted OR 2.67 (95% CI 1.55–4.62), p < 0.001, adjusted OR 1.23 (95% CI 1.11–1.43), p < 0.001, respectively)].

Conclusion

Sonographic head circumference and birth weight are not associated with OASIS occurrence among primiparous women delivering by an unassisted vaginal delivery. Prolonged second stage and the use of epidural analgesia are modifiable risk factors among these women.

Waldman R. ACOG Practice Bulletin No. 198: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol. 2019;133:185.PubMed

Friedman AM, Ananth CV, Prendergast E, D’Alton ME, Wright JD. Evaluation of third-degree and fourth-degree laceration rates as quality indicators. Obstet Gynecol. 2015;125:927–37.PubMed

Dudding TC, Vaizey CJ, Kamm MA. Obstetric anal sphincter injury: incidence, risk factors, and management. Ann Surg. 2008;247:224–37.PubMed

Nordenstam J, Altman D, Brismar S, Zetterström J. Natural progression of anal incontinence after childbirth. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1029–35.PubMed

Bols EM, Hendriks EJ, Berghmans BC, Baeten CG, Nijhuis JG, de Bie RA. A systematic review of etiological factors for postpartum fecal incontinence. Acta Obstet Gynecol Scand. 2010;89:302–14.PubMed

Laine K, Gissler M, Pirhonen J. Changing incidence of anal sphincter tears in four Nordic countries through the last decades. Eur J Obstet Gynecol Reprod Biol. 2009;146:71–5.PubMed

Jangö H, Langhoff-Roos J, Rosthøj S, Sakse A. Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population-based cohort study. Am J Obstet Gynecol. 2014;210(59):e51–6.

Gundabattula SR, Surampudi K. Risk factors for obstetric anal sphincter injuries (OASI) at a tertiary centre in south India. Int Urogynecol J. 2018;29:391–6.PubMed

Räisänen S, Vehviläinen-Julkunen K, Gissler M, Heinonen S. High episiotomy rate protects from obstetric anal sphincter ruptures: a birth register-study on delivery intervention policies in Finland. Scand J Public Health. 2011;39:457–63.PubMed

10.

de Leeuw JW, de Wit C, Kuijken JP, Bruinse HW. Mediolateral episiotomy reduces the risk for anal sphincter injury during operative vaginal delivery. BJOG. 2008;115:104–8.PubMed

11.

Kabiri D, Lipschuetz M, Cohen SM, Yagel O, Levitt L, Herzberg S, et al. Vacuum extraction failure is associated with a large head circumference. J Matern Fetal Neonatal Med. 2019;32:3325–30.PubMed

12.

Lipschuetz M, Cohen SM, Ein-Mor E, Sapir H, Hochner-Celnikier D, Porat S, et al. A large head circumference is more strongly associated with unplanned cesarean or instrumental delivery and neonatal complications than high birthweight. Am J Obstet Gynecol. 2015;213(833):e831–833.e812.

13.

Valsky DV, Lipschuetz M, Bord A, Eldar I, Messing B, Hochner-Celnikier D, et al. Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol. 2009;201(91):e91–7.

14.

Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144:768–73.PubMed

15.

Bulletins-Obstetrics ACoOaGCoP. ACOG Practice Bulletin Number 49, December 2003: Dystocia and augmentation of labor. Obstet Gynecol. 2003;102:1445–54.

16.

Salomon LJ, Alfirevic Z, Da Silva CF, Deter RL, Figueras F, Ghi T, et al. ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound Obstet Gynecol. 2019;53:715–23.PubMed

17.

Hadlock FP, Harrist RB, Carpenter RJ, Deter RL, Park SK. Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology. 1984;150:535–40.PubMed

18.

Kudish B, Sokol RJ, Kruger M. Trends in major modifiable risk factors for severe perineal trauma, 1996-2006. Int J Gynaecol Obstet. 2008;102:165–70.PubMedPubMedCentral

19.

Baghestan E, Irgens LM, Børdahl PE, Rasmussen S. Trends in risk factors for obstetric anal sphincter injuries in Norway. Obstet Gynecol. 2010;116:25–34.PubMed

20.

Melamed N, Yogev Y, Danon D, Mashiach R, Meizner I, Ben-Haroush A. Sonographic estimation of fetal head circumference: how accurate are we? Ultrasound Obstet Gynecol. 2011;37:65–71.PubMed

21.

Richter HE, Brumfield CG, Cliver SP, Burgio KL, Neely CL, Varner RE. Risk factors associated with anal sphincter tear: a comparison of primiparous patients, vaginal births after cesarean deliveries, and patients with previous vaginal delivery. Am J Obstet Gynecol. 2002;187:1194–8.PubMed

22.

Revicky V, Nirmal D, Mukhopadhyay S, Morris EP, Nieto JJ. Could a mediolateral episiotomy prevent obstetric anal sphincter injury? Eur J Obstet Gynecol Reprod Biol. 2010;150:142–6.PubMed

23.

Gerdin E, Sverrisdottir G, Badi A, Carlsson B, Graf W. The role of maternal age and episiotomy in the risk of anal sphincter tears during childbirth. Aust N Z J Obstet Gynaecol. 2007;47:286–90.PubMed

24.

Loewenberg-Weisband Y, Grisaru-Granovsky S, Ioscovich A, Samueloff A, Calderon-Margalit R. Epidural analgesia and severe perineal tears: a literature review and large cohort study. J Matern Fetal Neonatal Med. 2014;27:1864–9.PubMed

25.

Edqvist M, Hildingsson I, Mollberg M, Lundgren I, Lindgren H. Midwives’ management during the second stage of labor in relation to second-degree tears–an experimental study. Birth. 2017;44:86–94.PubMed

26.

Ginath S, Mizrachi Y, Bar J, Condrea A, Kovo M. Obstetric anal sphincter injuries (OASIs) in Israel: a review of the incidence and risk factors. Rambam Maimonides Med J. 2017;8.

27.

Levin G, Rottenstreich A, Cahan T, Ilan H, Shai D, Tsur A, Meyer R. Does birthweight have a role in the effect of episiotomy on anal sphincter injury? Arch Gynecol Obstet 2020.

Title: Sonographic fetal head circumference and the risk of obstetric anal sphincter injury following vaginal delivery
Authors: Raanan Meyer
Amihai Rottenstreich
Michal Zamir
Hadas Ilan
Edward Ram
Menachem Alcalay
Gabriel Levin
Publication date: 01-11-2020
Publisher: Springer International Publishing
Keyword: Episiotomy
Published in: International Urogynecology Journal / Issue 11/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04296-3

At a glance: The STEP trials

Springer Medicine

Sonographic fetal head circumference and the risk of obstetric anal sphincter injury following vaginal delivery

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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