Obstetric anal sphincter injury after episiotomy in vacuum extraction: an epidemiological study using an emulated randomised trial approach.
Causal inference
inverse treatment probability weighting
obstetric anal sphincter injury
propensity score
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
accepted:
28
01
2021
pubmed:
5
2
2021
medline:
1
9
2021
entrez:
4
2
2021
Statut:
ppublish
Résumé
To emulate a randomised controlled trial investigating whether lateral or mediolateral episiotomy compared with no episiotomy reduces the prevalence of obstetric anal sphincter injury (OASIS) in nulliparous women delivered with vacuum extraction. A population-based observational study. Sweden. 63 654 nulliparous women delivered with vacuum extraction derived from the Swedish Medical Birth Register 2000-2011, with a live singleton baby with no known malformations in cephalic presentation in gestational week ≥34 The effect of episiotomy was calculated using a causal doubly robust estimation method based on propensity scores. Results are presented as the average treatment effect and numbers needed to treat (NNT). OASIS (third- and fourth-degree perineal injury) in nulliparous women delivered with vacuum extraction. Episiotomy was associated with a reduction in OASIS from 15.5% to 11.8%, average treatment effect of -3.66% (95% CI -4.31 to -3.01) and NNT 27. Third-degree perineal injuries were reduced from 14.0% to 10.9% (-3.08, 95% CI -3.71 to -2.42) with NNT 32. Fourth-degree perineal injuries were reduced from 1.6% to 1.0 % (-0.58%, 95% CI -0.79 to -0.37) with NNT 172. Lateral or mediolateral episiotomy reduced the prevalence of OASIS in nulliparous women delivered with vacuum extraction, compared to women with no episiotomy. To prevent one case of OASIS in first-time mothers delivered with vacuum, 27 episiotomies had to be performed.
Identifiants
pubmed: 33539612
doi: 10.1111/1471-0528.16663
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1663-1671Subventions
Organisme : Vetenskapsrådet
ID : 2016-00526
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
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