A randomized control trial evaluating the prevalence of obstetrical anal sphincter injuries in primigravida in routine versus selective mediolateral episiotomy

Aqmar S. Sulaiman, Shuhaila Ahmad, Nor Azlin Mohamed Ismail, Rahana Abd Rahman, Muhammad A. Jamil, Ahmad Z. Mohd Dali

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6 Citations (Scopus)

Abstract

Objectives: To evaluate the prevalence of obstetrical anal sphincter injuries (OASIS), which include third and fourth degree perineal tears in primigravida in routine versus selective mediolateral episiotomy. Secondly, to determine the rate of episiotomy in local settings. Methods: This randomized control trial was carried out in the labor ward of a tertiary hospital of the Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia between May and October 2009. The trial included 171 primigravida beyond 38 weeks gestation who achieved vaginal delivery, and randomly assigned to selective and routine episiotomy groups. The type of perineal injuries following childbirth among 171 women were evaluated. Results: The overall episiotomy rate from both groups was 76.6%. The prevalence of third degree perineal tears was 3.7% in the routine compared with selective mediolateral episiotomy at 1.1%. There was no occurrence of fourth degree tears in both groups. However, selective mediolateral episiotomy was associated with an increased risk of periurethral and labial injury compared with the routine group (4.5% versus 0%). Conclusion: Routine mediolateral episiotomy in primigravida is associated with a higher prevalence of obstetrical anal sphincter injuries. As anal sphincter injuries are known to have morbidities, selective mediolateral episiotomy in primigravida is therefore recommended in the implementation of new delivery practice, and in an attempt to reduce our high episiotomy rate.

Original languageEnglish
Pages (from-to)819-823
Number of pages5
JournalSaudi Medical Journal
Volume34
Issue number8
Publication statusPublished - Aug 2013

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Episiotomy
Anal Canal
Wounds and Injuries
Tears
Malaysia
Lip
Tertiary Care Centers
Parturition
Morbidity
Pregnancy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "A randomized control trial evaluating the prevalence of obstetrical anal sphincter injuries in primigravida in routine versus selective mediolateral episiotomy",
abstract = "Objectives: To evaluate the prevalence of obstetrical anal sphincter injuries (OASIS), which include third and fourth degree perineal tears in primigravida in routine versus selective mediolateral episiotomy. Secondly, to determine the rate of episiotomy in local settings. Methods: This randomized control trial was carried out in the labor ward of a tertiary hospital of the Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia between May and October 2009. The trial included 171 primigravida beyond 38 weeks gestation who achieved vaginal delivery, and randomly assigned to selective and routine episiotomy groups. The type of perineal injuries following childbirth among 171 women were evaluated. Results: The overall episiotomy rate from both groups was 76.6{\%}. The prevalence of third degree perineal tears was 3.7{\%} in the routine compared with selective mediolateral episiotomy at 1.1{\%}. There was no occurrence of fourth degree tears in both groups. However, selective mediolateral episiotomy was associated with an increased risk of periurethral and labial injury compared with the routine group (4.5{\%} versus 0{\%}). Conclusion: Routine mediolateral episiotomy in primigravida is associated with a higher prevalence of obstetrical anal sphincter injuries. As anal sphincter injuries are known to have morbidities, selective mediolateral episiotomy in primigravida is therefore recommended in the implementation of new delivery practice, and in an attempt to reduce our high episiotomy rate.",
author = "Sulaiman, {Aqmar S.} and Shuhaila Ahmad and {Mohamed Ismail}, {Nor Azlin} and {Abd Rahman}, Rahana and Jamil, {Muhammad A.} and {Mohd Dali}, {Ahmad Z.}",
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AU - Sulaiman, Aqmar S.

AU - Ahmad, Shuhaila

AU - Mohamed Ismail, Nor Azlin

AU - Abd Rahman, Rahana

AU - Jamil, Muhammad A.

AU - Mohd Dali, Ahmad Z.

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N2 - Objectives: To evaluate the prevalence of obstetrical anal sphincter injuries (OASIS), which include third and fourth degree perineal tears in primigravida in routine versus selective mediolateral episiotomy. Secondly, to determine the rate of episiotomy in local settings. Methods: This randomized control trial was carried out in the labor ward of a tertiary hospital of the Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia between May and October 2009. The trial included 171 primigravida beyond 38 weeks gestation who achieved vaginal delivery, and randomly assigned to selective and routine episiotomy groups. The type of perineal injuries following childbirth among 171 women were evaluated. Results: The overall episiotomy rate from both groups was 76.6%. The prevalence of third degree perineal tears was 3.7% in the routine compared with selective mediolateral episiotomy at 1.1%. There was no occurrence of fourth degree tears in both groups. However, selective mediolateral episiotomy was associated with an increased risk of periurethral and labial injury compared with the routine group (4.5% versus 0%). Conclusion: Routine mediolateral episiotomy in primigravida is associated with a higher prevalence of obstetrical anal sphincter injuries. As anal sphincter injuries are known to have morbidities, selective mediolateral episiotomy in primigravida is therefore recommended in the implementation of new delivery practice, and in an attempt to reduce our high episiotomy rate.

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