Hanoch Schreiber1,2, Nir Mevorach3,4, Maya Sharon-Weiner3,4, Sivan Farladansky-Gershnabel3,4, Gil Shechter Maor3,4, Tal Biron-Shental3,4. 1. Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel. hanochsc@gmail.com. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. hanochsc@gmail.com. 3. Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel. 4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
PURPOSE: This study evaluated whether episiotomy during vacuum-assisted delivery leads to fewer third- and fourth-degree tears. METHODS: This was a retrospective cohort study of all nulliparas who underwent a singleton, soft cup, vacuum-assisted vaginal delivery in one institution, from January 2014 to August 2019. Failed vacuum deliveries were excluded. Based on power analysis calculation, a sample size of 500 women in each group was sufficient to detect an advantage of episiotomy, if present. Primary outcome was third- or fourth-degree perineal tear. Secondary outcomes were other maternal complications, and low neonatal cord pH and Apgar scores. Outcomes were compared between women with and without episiotomy. RESULTS: During the study period, 2370 nulliparas had a vacuum-assisted vaginal delivery using soft vacuum cup and met the study inclusion criteria. Episiotomy was performed in 1868 (79%) women, and 502 (21%) delivered without episiotomy. Background characteristics were similar in both groups. There were no significant differences in the rates of third and fourth grade perineal lacerations between the two groups. Episiotomy was associated with higher rate of postpartum hemorrhage (p < 0.01) CONCLUSIONS: Using selective episiotomy for patients delivering vaginally with the assistance of soft cap vacuum does not increase third- or fourth-degree perineal tears.
PURPOSE: This study evaluated whether episiotomy during vacuum-assisted delivery leads to fewer third- and fourth-degree tears. METHODS: This was a retrospective cohort study of all nulliparas who underwent a singleton, soft cup, vacuum-assisted vaginal delivery in one institution, from January 2014 to August 2019. Failed vacuum deliveries were excluded. Based on power analysis calculation, a sample size of 500 women in each group was sufficient to detect an advantage of episiotomy, if present. Primary outcome was third- or fourth-degree perineal tear. Secondary outcomes were other maternal complications, and low neonatal cord pH and Apgar scores. Outcomes were compared between women with and without episiotomy. RESULTS: During the study period, 2370 nulliparas had a vacuum-assisted vaginal delivery using soft vacuum cup and met the study inclusion criteria. Episiotomy was performed in 1868 (79%) women, and 502 (21%) delivered without episiotomy. Background characteristics were similar in both groups. There were no significant differences in the rates of third and fourth grade perineal lacerations between the two groups. Episiotomy was associated with higher rate of postpartum hemorrhage (p < 0.01) CONCLUSIONS: Using selective episiotomy for patients delivering vaginally with the assistance of soft cap vacuum does not increase third- or fourth-degree perineal tears.
Authors: A H Sultan; R Thakar; K M Ismail; V Kalis; K Laine; S H Räisänen; J W de Leeuw Journal: Eur J Obstet Gynecol Reprod Biol Date: 2019-07-09 Impact factor: 2.435
Authors: David Segal; Yael Baumfeld; Lior Yahav; David Yohay; Yael Geva; Fernanda Press; Adi Y Weintraub Journal: J Matern Fetal Neonatal Med Date: 2018-09-19