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Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study.

https://arctichealth.org/en/permalink/ahliterature126440
Source
BJOG. 2012 May;119(6):724-30
Publication Type
Article
Date
May-2012
Author
M. Stedenfeldt
J. Pirhonen
E. Blix
T. Wilsgaard
B. Vonen
P. Øian
Author Affiliation
The Norwegian Continence and Pelvic Floor Centre, University Hospital of North Norway, Tromsø, Norway. mona.stedenfeldt@unn.no
Source
BJOG. 2012 May;119(6):724-30
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Anal Canal - injuries
Case-Control Studies
Episiotomy - adverse effects - methods
Female
Humans
Obstetric Labor Complications - etiology - surgery
Pregnancy
Risk factors
Abstract
To investigate the association between the geometrical properties of episiotomy and obstetric anal sphincter injuries (OASIS) because episiotomies angled at 40-60° are associated with fewer OASIS than episiotomies with more acute angles.
Case-control study.
University Hospital of North Norway, Tromsø and Nordland Hospital, Bodø, Norway.
Seventy-four women who had one vaginal birth and episiotomy. Cases (n = 37) have sustained OASIS at birth, while controls (n = 37) had not. The groups were matched for instrumental delivery.
Two groups of women with history of only one vaginal birth were compared. Episiotomy scar was identified and photographed and relevant measures were taken. Data were analysed using conditional logistic analysis.
Mean episiotomy angle, length, depth, incision point.
The risk of sustaining OASIS decreased by 70% (odds ratio [OR] 0.30; 95% CI 0.14-0.66) for each 5.5-mm increase in episiotomy depth, decreased by 56% (OR 0.44; 95% CI 0.23-0.86) for each 4.5-mm increase in the distance from the midline to the incision point of the episiotomy, and decreased by 75% (OR 0.25; 95% CI 0.10-0.61) for each 5.5-mm increase in episiotomy length. Lastly, there was no difference in mean angle between groups but there was a "U-shaped" association between angle and OASIS (OR 2.09; 95% CI 1.02-4.28) with an increased risk (OR 9.00; 95% CI 1.1-71.0) of OASIS when the angle was either smaller than 15° or >60°.
The present study showed that scarred episiotomies with depth > 16 mm, length > 17 mm, incision point > 9 mm lateral of midpoint and angle range 30-60° are significantly associated with less risk of OASIS. Shrinkage of tissue must be considered.
Notes
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Comment In: BJOG. 2012 Aug;119(9):1148; author reply 1148-922780821
Comment In: BJOG. 2012 Aug;119(9):1147; author reply 1148-922780819
PubMed ID
22390647 View in PubMed
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Risk factors for obstetric anal sphincter injury after a successful multicentre interventional programme.

https://arctichealth.org/en/permalink/ahliterature113819
Source
BJOG. 2014 Jan;121(1):83-91
Publication Type
Article
Date
Jan-2014
Author
M. Stedenfeldt
P. Øian
M. Gissler
E. Blix
J. Pirhonen
Author Affiliation
The Norwegian Continence and Pelvic Floor Centre, University Hospital of North Norway, Tromsø, Norway; Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
Source
BJOG. 2014 Jan;121(1):83-91
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Adult
Anal Canal - injuries
Birth weight
Cohort Studies
Delivery, Obstetric - methods - statistics & numerical data
Episiotomy - utilization
Extraction, Obstetrical - utilization
Female
Humans
Logistic Models
Norway - epidemiology
Obstetric Labor Complications - epidemiology - prevention & control
Obstetrical Forceps - utilization
Odds Ratio
Parity
Pregnancy
Risk factors
Young Adult
Abstract
To evaluate and compare the risk profile of sustaining obstetric anal sphincter injuries (OASIS) and associated risks in five risk groups (low to high), after the OASIS rate was reduced from 4.6% to 2.0% following an interventional programme. The main focus of the intervention was on manual assistance during the final part of second stage of labour.
A multicentre interventional cohort study with before and after comparison.
Four Norwegian obstetric departments.
A total of 40,154 vaginal deliveries in 2003-09.
Pre-intervention and postintervention analyses. The associations of OASIS with possible risk factors were estimated using odds ratios obtained by logistic regression.
Risk factors of OASIS.
The risk of sustaining OASIS decreased by 59% (odds ratio [OR] 0.41; 95% confidence interval [95% CI] 0.36-0.46) after the intervention. Associations with obstetric risks for OASIS were largely unchanged after the intervention, including first vaginal delivery (OR 3.84; 95% CI 2.90-5.07), birthweight = 4500 g (OR 4.42; 95% CI 2.68-7.27), forceps delivery (OR 3.54; 95% CI 1.99-6.29) and mediolateral episiotomy (OR 0.89; 95% CI 0.70-1.12). However, the highest reduction of OASIS, (65%), was observed in group 0 (low-risk) (OR 0.35; 95% CI 0.24-0.51), and a 57% (OR 0.43; 95% CI 0.35-0.52), 61% (OR 0.39; 95% CI 0.31-0.48), and 58% (OR 0.42; 95% CI 0.30-0.60) reduction in groups with one, two and three risk factors, respectively. No change was observed in the group with four risk factors.
After the intervention the most significant decrease of OASIS was observed in low-risk births, although the main risk factors for OASIS remained unchanged.
PubMed ID
23682573 View in PubMed
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Sacral neuromodulation for faecal incontinence following obstetric sphincter injury - outcome of percutaneous nerve evaluation.

https://arctichealth.org/en/permalink/ahliterature285758
Source
Colorectal Dis. 2017 Mar;19(3):274-282
Publication Type
Article
Date
Mar-2017
Author
M B Rydningen
T. Dehli
T. Wilsgaard
R O Lindsetmo
M. Kumle
M. Stedenfeldt
S. Norderval
Source
Colorectal Dis. 2017 Mar;19(3):274-282
Date
Mar-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anal Canal - diagnostic imaging - injuries
Delivery, Obstetric - adverse effects
Electric Stimulation Therapy
Endosonography
Fecal Incontinence - etiology - therapy
Female
Humans
Linear Models
Lumbosacral Plexus
Middle Aged
Multivariate Analysis
Norway
Prospective Studies
Treatment Outcome
Urinary Incontinence - etiology
Abstract
The purpose of this study was to assess the efficacy of percutaneous nerve evaluation (PNE) in women with faecal incontinence (FI) following obstetric anal sphincter injury and to relate the outcomes to baseline factors, with special emphasis on the extent of the sphincter defect.
This was a prospective study at a tertiary colorectal referral unit at the University Hospital of North Norway conducted from 2012 to 2014. Sixty-three women underwent a 3-week PNE using a tined lead and the Verify(®) external neurostimulator. The primary outcome was efficacy, defined as the percentage reduction in weekly FI episodes, and patients with a reduction of 50% or more were defined as responders. Baseline factors affecting the primary outcome were explored. Sphincter defects were classified with a validated three-dimensional endoanal ultrasound defect score.
Fifty-six (89%) of the 63 women were responders with a reduction in weekly FI episodes of 94.5%, from a median (interquartile range) of 4.8 (2.0-11.0) to 0.5 (0-2.0) (P 
PubMed ID
27463362 View in PubMed
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