Archives of Gynecology and Obstetrics

, Volume 300, Issue 1, pp 87–94 | Cite as

Does the implementation of a restrictive episiotomy policy for operative deliveries increase the risk of obstetric anal sphincter injury?

  • Bertrand GachonEmail author
  • Carine Fradet Menard
  • Fabrice Pierre
  • Xavier Fritel
Maternal-Fetal Medicine



Our main objective was to investigate whether the implementation of a restrictive episiotomy policy in operative deliveries changes the incidence of obstetric anal sphincter injury (OASI).


This is an observational study over an 11-year period in Poitiers University Maternity, France. We included women with vaginal operative deliveries after 34 gestational weeks for singleton births in cephalic presentation. We collected data on the mother and operative delivery characteristics: indication, instrument, epidural analgesia, labor length, episiotomy, OASI, and birthweight. We investigated the changes in the mediolateral episiotomy (MLE) and OASI rates and the association between MLE and OASI. The primary outcome was the evolution of the OASI and MLE rates. The secondary outcome was the occurrence of OASI during operative delivery with or without MLE.


In total, 2357 operative deliveries were assessed, including 847 vacuum-, 1350 forceps- and 160 spatula-assisted deliveries. Of these, 950 were performed with MLE and 1407 without; 37 OASIs (3.9%) occurred in the MLE group, and 137 (9.7%) in the no-MLE group. Between 2005 and 2015, MLE use decreased from 78.5 to 16.2% and OASI occurrence increased from 3.1 to 12.7%. The increase in OASI occurrence was significant for forceps deliveries, but not for vacuum or spatula deliveries. Operative delivery with MLE was associated with a three times lower OASI occurrence than that without MLE (adjusted OR = 0.29, 95% CI [0.20–0.43]).


Implementation of a restrictive MLE policy for operative delivery seems to be associated with an increase in OASI incidence with forceps, but not with vacuum.


Obstetric anal sphincter injury Episiotomy Instrumental delivery Perineal trauma Childbirth 


Author contributions

BG: wrote the main text of this manuscript, contribution to the study design, contribution to data analysis and interpretation, contribution to statistical analysis. He wrote the revised version of the manuscript. CFM: data collection, data analysis, statistical analysis, and review of each version of the manuscript. She reviewed the revised version of the manuscript. FP: contribution to the study design, contribution to data analysis and interpretation and review of each version of the manuscript. She reviewed the revised version of the manuscript. XF: contribution to the study design, contribution to data analysis and interpretation, contribution to statistical analysis, draft the work. She reviewed the revised version of the manuscript.


There was no funding for this study.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to disclose.

Ethical approval

Ethical committee approval was not required for this study because we solely reported on anonymized data from patient’s medical records. These data have been collected in accordance with our usual practices and patients underwent no supplementary procedures for this investigation. Upon admission, each patient at our institution receives an institutional chart that specifically mention the possibility that anonymized medical data collected during hospitalization could be used for medical research.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyLa Miletrie University HospitalPoitiers CedexFrance
  2. 2.INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexuality and Health Team, Univ Paris-Sud, UMRS 1018OrsayFrance
  3. 3.INSERM CIC-P 1402, La Miletrie University HospitalPoitiersFrance

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