( BJOG . 2024;131:1824-1831. doi: 10.1111/1471-0528.17914) Third-degree and fourth-degree perineal lacerations are serious complications of vaginal delivery (VD) and are referred to as obstetric anal sphincter injuries (OASIS). These lacerations are associated with both short-term and long-term symptoms, including anal incontinence, dyspareunia, pain, and posttraumatic stress disorder, even though they are typically immediately surgically repaired. One of the most crucial risk factors for OASIS is operative VD, with the prevalence increased more in forceps delivery than vacuum delivery; most studies up to this point have used spontaneous VD as a control, which is a major methodological flaw. In Norway, a national care bundle surrounding VD has managed to greatly reduce OASIS incidence since 2005, which included manual perineal protection, episiotomy based on indication, and careful communication. Recent data have provided evidence that mediolateral and lateral episiotomies are protective against OASIS in operative VD, while median episiotomy increases the risk. This study was designed to understand the prevalence and trends surrounding OASIS in both vacuum and forceps deliveries in Norway with and without episiotomy.
Fodstad et al. (Wed,) studied this question.
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