TY - JOUR
T1 - Morbidity experienced by women before and after operative vaginal delivery
T2 - prospective cohort study nested within a two-centre RCT of restrictive versus routine use of episiotomy
AU - Macleod, M.
AU - Goyder, K.
AU - Howarth, L.
AU - Bahl, R.
AU - Strachan, B.
AU - Murphy, D. J.
PY - 2013/7
Y1 - 2013/7
N2 - ObjectiveTo explore: (1) the antenatal and postnatal morbidity experienced by women in relation to operative vaginal delivery (OVD); and (2) the impact of restrictive versus routine use of episiotomy.DesignLongitudinal prospective cohort study embedded within a two-centre randomised controlled trial (RCT).SettingTwo UK tertiary-level maternity units.PopulationAntenatally recruited participants of an RCT of restrictive versus routine use of episiotomy at OVD.MethodsA self-completing questionnaire was administered antenatally, before hospital discharge, at 6 weeks and at 1 year postpartum.Main outcome measuresUrinary and anal incontinence, dyspareunia, perineal pain and psychological morbidity.ResultsLongitudinal data have revealed that morbidities historically associated with OVD were often as prevalent, if not more prevalent, in the third trimester of pregnancy than postpartum. Restrictive episiotomy use was associated with: a higher incidence of perineal pain in the immediate postpartum period (98.9% restrictive versus 87.8% routine, RR 1.10, 95% CI 1.01–1.21); greater psychological morbidity in the immediate postpartum period (mean scores on the Edinburgh Postnatal Depression Scale, Edinburgh Postnatal Depression Score (EPDS) 6.7 restrictive versus 5.1 routine; P = 0.01 ); and more stress urinary incontinence at 6 weeks postpartum (42.2% restrictive versus 27.2% routine, RR 1.55, 95% CI 1.00–2.40); however, this had resolved by 1 year. No other differences were found between the groups at 6 weeks and 1 year postpartum.ConclusionsMorbidities previously attributed to OVD may in fact be present antenatally, to a greater or similar degree. A restrictive approach to the use of episiotomy at OVD may increase rates of urinary morbidity, in particular stress incontinence and perineal pain, in the immediate postpartum period.
AB - ObjectiveTo explore: (1) the antenatal and postnatal morbidity experienced by women in relation to operative vaginal delivery (OVD); and (2) the impact of restrictive versus routine use of episiotomy.DesignLongitudinal prospective cohort study embedded within a two-centre randomised controlled trial (RCT).SettingTwo UK tertiary-level maternity units.PopulationAntenatally recruited participants of an RCT of restrictive versus routine use of episiotomy at OVD.MethodsA self-completing questionnaire was administered antenatally, before hospital discharge, at 6 weeks and at 1 year postpartum.Main outcome measuresUrinary and anal incontinence, dyspareunia, perineal pain and psychological morbidity.ResultsLongitudinal data have revealed that morbidities historically associated with OVD were often as prevalent, if not more prevalent, in the third trimester of pregnancy than postpartum. Restrictive episiotomy use was associated with: a higher incidence of perineal pain in the immediate postpartum period (98.9% restrictive versus 87.8% routine, RR 1.10, 95% CI 1.01–1.21); greater psychological morbidity in the immediate postpartum period (mean scores on the Edinburgh Postnatal Depression Scale, Edinburgh Postnatal Depression Score (EPDS) 6.7 restrictive versus 5.1 routine; P = 0.01 ); and more stress urinary incontinence at 6 weeks postpartum (42.2% restrictive versus 27.2% routine, RR 1.55, 95% CI 1.00–2.40); however, this had resolved by 1 year. No other differences were found between the groups at 6 weeks and 1 year postpartum.ConclusionsMorbidities previously attributed to OVD may in fact be present antenatally, to a greater or similar degree. A restrictive approach to the use of episiotomy at OVD may increase rates of urinary morbidity, in particular stress incontinence and perineal pain, in the immediate postpartum period.
KW - episiotomy
KW - operative vaginal delivery
KW - pelvic floor morbidity
KW - RCT
U2 - 10.1111/1471-0528.12184
DO - 10.1111/1471-0528.12184
M3 - Article
SN - 1470-0328
VL - 120
SP - 1020
EP - 1027
JO - BJOG: An International Journal of Obstetrics & Gynaecology
JF - BJOG: An International Journal of Obstetrics & Gynaecology
IS - 8
ER -
