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04-05-2024 | Perineal Laceration | Original Article

Factors Associated with Obstetric Anal Sphincter Injury During Vacuum-Assisted Vaginal Delivery

Authors: Henry H. Chill, Aharon Dick, Wajdy Zarka, Naama Vilk Ayalon, Joshua I. Rosenbloom, David Shveiky, Gilad Karavani

Published in: International Urogynecology Journal

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Abstract

Introduction and Hypothesis

Obstetric anal sphincter injury (OASI) is a major complication associated with vacuum-assisted vaginal delivery (VAVD). The aim of this study was to evaluate risk factors related to vacuum extraction that are associated with OASI.

Methods

This was a case–control study performed at a tertiary university teaching hospital. Included were patients aged 18–45 years who had a singleton pregnancy resulting in a live, term, VAVD. The study group consisted of women diagnosed with OASI following vacuum extraction. The control group included women following VAVD without OASI. Matching at a ratio of 1:2 was performed. Groups were compared regarding demographic, obstetric. and labor-related parameters, specifically focusing on variables related to the vacuum procedure itself.

Results

One hundred and ten patients within the study group and 212 within the control group were included in the final analysis. Patients in the OASI group were more likely to undergo induction of labor, use of oxytocin during labor, increased second stage of labor, higher likelihood of the operator being a resident, increased number of pulls, procedure lasting under 10 min, occipito-posterior head position at vacuum initiation, episiotomy, increased neonatal head circumference, and birthweight. Multivariate logistic regression analysis revealed that increased week of gestation (OR 1.67, 95% CI 1.25–2.22, p < 0.001), unsupervised resident performing the procedure (OR 4.63, 95% CI 2.17–9.90), p < 0.001), indication of VAVD being fetal distress (OR 2.72, 95% CI 1.04–7.10, p = 0.041), and length of procedure under 10 min (OR 4.75, 95% CI 1.53–14.68, p = 0.007) were associated with OASI. Increased maternal age was associated with lower risk of OASI (OR 0.9, 95% CI 0.84–0.98, p = 0.012).

Conclusions

When performing VAVD, increased week of gestation, unsupervised resident performing the procedure, fetal distress as vacuum indication, and vacuum procedure under 10 min were associated with OASI. In contrast, increased maternal age was shown to be a protective factor.
Literature
1.
go back to reference Poignant M, Hjelmstedt A, Ekeus C. Indications for operative delivery between 1999–2010 and induction of labor and epidural analgesia on the risk of operative delivery—a population based Swedish register study. Sex Reprod Health. 2012;3:129–34.CrossRef Poignant M, Hjelmstedt A, Ekeus C. Indications for operative delivery between 1999–2010 and induction of labor and epidural analgesia on the risk of operative delivery—a population based Swedish register study. Sex Reprod Health. 2012;3:129–34.CrossRef
2.
go back to reference Mola GD, Kuk J. Operative vaginal delivery at Port Moresby General Hospital from 1977 to 2010. P N G Med J. 2011;54(3–4):174–84.PubMed Mola GD, Kuk J. Operative vaginal delivery at Port Moresby General Hospital from 1977 to 2010. P N G Med J. 2011;54(3–4):174–84.PubMed
3.
go back to reference Cammu H, Martens G, Keirse MJ. Mothers’ level of education and childbirth interventions: a population-based study in Flanders, Northern Belgium. Birth. 2011;38(3):191–9.CrossRefPubMed Cammu H, Martens G, Keirse MJ. Mothers’ level of education and childbirth interventions: a population-based study in Flanders, Northern Belgium. Birth. 2011;38(3):191–9.CrossRefPubMed
4.
go back to reference Kramer MS, Berg C, Abenhaim H, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209(5):449.e1–7.CrossRefPubMed Kramer MS, Berg C, Abenhaim H, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209(5):449.e1–7.CrossRefPubMed
5.
go back to reference Sheiner E, Sarid L, Levy A, Seidman DS, Hallak M. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J Matern Fetal Neonatal Med. 2005;18:149–54.CrossRefPubMed Sheiner E, Sarid L, Levy A, Seidman DS, Hallak M. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J Matern Fetal Neonatal Med. 2005;18:149–54.CrossRefPubMed
6.
go back to reference Hildingsson I, Karlstrom A, Nystedt A. Parents’ experiences of an instrumental vaginal birth findings from a regional survey in Sweden. Sex Reprod Healthc. 2013;4:3–8.CrossRefPubMed Hildingsson I, Karlstrom A, Nystedt A. Parents’ experiences of an instrumental vaginal birth findings from a regional survey in Sweden. Sex Reprod Healthc. 2013;4:3–8.CrossRefPubMed
7.
go back to reference Ekéus C, Nilsson E, Gottvall K. Increasing incidence of anal sphincter tears among primiparas in Sweden: a population-based register study. Acta Obstet Gynecol Scand. 2008;87:564–73.CrossRefPubMed Ekéus C, Nilsson E, Gottvall K. Increasing incidence of anal sphincter tears among primiparas in Sweden: a population-based register study. Acta Obstet Gynecol Scand. 2008;87:564–73.CrossRefPubMed
8.
go back to reference De Leeuw JW, Struijk PC, Vierhout ME, Wallenburg HC. Risk factors for third degree perineal ruptures during delivery. BJOG. 2001;108:383–7.PubMed De Leeuw JW, Struijk PC, Vierhout ME, Wallenburg HC. Risk factors for third degree perineal ruptures during delivery. BJOG. 2001;108:383–7.PubMed
9.
go back to reference Handa VL, Danielsen BH, Gilbert WM. Obstetric anal sphincter lacerations. Obstet Gynecol. 2001;98:225–30.PubMed Handa VL, Danielsen BH, Gilbert WM. Obstetric anal sphincter lacerations. Obstet Gynecol. 2001;98:225–30.PubMed
10.
go back to reference Christianson LM, Bovbjerg VE, McDavitt EC, Hullfish KL. Risk factors for perineal injury during delivery. Am J Obstet Gynecol. 2003;189:255–60.CrossRefPubMed Christianson LM, Bovbjerg VE, McDavitt EC, Hullfish KL. Risk factors for perineal injury during delivery. Am J Obstet Gynecol. 2003;189:255–60.CrossRefPubMed
11.
go back to reference Jango H, Langhoff-Roos J, Rosthoj S, Sakse A. Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population-based cohort study. Am J Obstet Gynecol. 2013;210(1):59.e1–6.CrossRefPubMed Jango H, Langhoff-Roos J, Rosthoj S, Sakse A. Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population-based cohort study. Am J Obstet Gynecol. 2013;210(1):59.e1–6.CrossRefPubMed
12.
go back to reference Gurol-Urganci I, Cromwell DA, Edozien LC, et al. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG. 2013;120:1516–25.CrossRefPubMed Gurol-Urganci I, Cromwell DA, Edozien LC, et al. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG. 2013;120:1516–25.CrossRefPubMed
13.
go back to reference Bergendahl S, Lindberg P, Brismar WS. Operator experience affects the risk of obstetric anal sphincter injury in vacuum extraction deliveries. Acta Obstet Gynecol Scand. 2019;98:787–94.CrossRefPubMed Bergendahl S, Lindberg P, Brismar WS. Operator experience affects the risk of obstetric anal sphincter injury in vacuum extraction deliveries. Acta Obstet Gynecol Scand. 2019;98:787–94.CrossRefPubMed
14.
go back to reference Ryman P, Ahlberg M, Ekeus C. Risk factors for anal sphincter tears in vacuum-assisted delivery. Sex Reprod Healthc. 2015;6(3):151–6.CrossRefPubMed Ryman P, Ahlberg M, Ekeus C. Risk factors for anal sphincter tears in vacuum-assisted delivery. Sex Reprod Healthc. 2015;6(3):151–6.CrossRefPubMed
15.
go back to reference Waldman R. ACOG practice bulletin No. 198: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol. 2019;133(1):185.CrossRefPubMed Waldman R. ACOG practice bulletin No. 198: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol. 2019;133(1):185.CrossRefPubMed
16.
go back to reference Chill HH, Guedalia J, Lipschuetz M, et al. Prediction model for obstetric anal sphincter injury using machine learning. Int Urogynecol J. 2021;32(9):2393–9.CrossRefPubMed Chill HH, Guedalia J, Lipschuetz M, et al. Prediction model for obstetric anal sphincter injury using machine learning. Int Urogynecol J. 2021;32(9):2393–9.CrossRefPubMed
17.
go back to reference Nakai A, Yoshida A, Yamaguchi S, et al. Incidence and risk factors for severe perineal laceration after vaginal delivery in Japanese patients. Arch Gynecol Obstet. 2006;274(4):222–6.CrossRefPubMed Nakai A, Yoshida A, Yamaguchi S, et al. Incidence and risk factors for severe perineal laceration after vaginal delivery in Japanese patients. Arch Gynecol Obstet. 2006;274(4):222–6.CrossRefPubMed
18.
go back to reference Meister MR, Cahill AG, Conner SN, et al. Predicting obstetric anal sphincter injuries in a modern obstetric population. Am J Obstet Gynecol. 2016;215(3):310.e1–7.CrossRefPubMed Meister MR, Cahill AG, Conner SN, et al. Predicting obstetric anal sphincter injuries in a modern obstetric population. Am J Obstet Gynecol. 2016;215(3):310.e1–7.CrossRefPubMed
19.
go back to reference Segal D, Baumfeld Y, Yahav L, et al. Risk factors for obstetric anal sphincter injuries (OASIS) during vacuum extraction delivery in a university affiliated maternity hospital. J Matern Fetal Neonatal Med. 2020;33(6):999–1003.CrossRefPubMed Segal D, Baumfeld Y, Yahav L, et al. Risk factors for obstetric anal sphincter injuries (OASIS) during vacuum extraction delivery in a university affiliated maternity hospital. J Matern Fetal Neonatal Med. 2020;33(6):999–1003.CrossRefPubMed
20.
go back to reference Levin G, Friedman T, Shai D, Alcalay M, Ram E, Meyer R. The association between vacuum-assisted vaginal delivery and anal sphincter injury. Int Urogynecol J. 2021;32(7):1771–7.CrossRefPubMed Levin G, Friedman T, Shai D, Alcalay M, Ram E, Meyer R. The association between vacuum-assisted vaginal delivery and anal sphincter injury. Int Urogynecol J. 2021;32(7):1771–7.CrossRefPubMed
21.
go back to reference Bligard KH, Lipsey KL, Young OM. Simulation training for operative vaginal delivery among obstetrics and gynecology residents: a systematic review. Obstet Gynecol. 2019;134(Suppl 1):16S–21S.CrossRefPubMed Bligard KH, Lipsey KL, Young OM. Simulation training for operative vaginal delivery among obstetrics and gynecology residents: a systematic review. Obstet Gynecol. 2019;134(Suppl 1):16S–21S.CrossRefPubMed
22.
go back to reference Mannella P, Giordano M, Guevara MMM, et al. Simulation training program for vacuum application to improve technical skills in vacuum-assisted vaginal delivery. BMC Pregnancy Childbirth. 2021;21(1):338.CrossRefPubMedPubMedCentral Mannella P, Giordano M, Guevara MMM, et al. Simulation training program for vacuum application to improve technical skills in vacuum-assisted vaginal delivery. BMC Pregnancy Childbirth. 2021;21(1):338.CrossRefPubMedPubMedCentral
23.
go back to reference Celentano C, Prefumo F, Matarrelli B, Mastracchio J, Mauri S, Rosati M. Comparison of practice vs theory model training for vacuum-assisted delivery: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2023;290:109–14.CrossRefPubMed Celentano C, Prefumo F, Matarrelli B, Mastracchio J, Mauri S, Rosati M. Comparison of practice vs theory model training for vacuum-assisted delivery: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2023;290:109–14.CrossRefPubMed
25.
go back to reference Levin G, Rottenstreich A, Tsur A, et al. Risk factors for obstetric anal sphincter injury among parous women. Arch Gynecol Obstet. 2021;303(3):709–14.CrossRefPubMed Levin G, Rottenstreich A, Tsur A, et al. Risk factors for obstetric anal sphincter injury among parous women. Arch Gynecol Obstet. 2021;303(3):709–14.CrossRefPubMed
26.
go back to reference Dey T, Mukherjee A, Chakraborty S. A practical overview of case-control studies in clinical practice. Chest. 2020;158(1S):S57–64.CrossRefPubMed Dey T, Mukherjee A, Chakraborty S. A practical overview of case-control studies in clinical practice. Chest. 2020;158(1S):S57–64.CrossRefPubMed
Metadata
Title
Factors Associated with Obstetric Anal Sphincter Injury During Vacuum-Assisted Vaginal Delivery
Authors
Henry H. Chill
Aharon Dick
Wajdy Zarka
Naama Vilk Ayalon
Joshua I. Rosenbloom
David Shveiky
Gilad Karavani
Publication date
04-05-2024
Publisher
Springer International Publishing
Published in
International Urogynecology Journal
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-024-05785-5