Morbidity experienced by women before and after operative vaginal delivery

prospective cohort study nested within a two-centre RCT of restrictive versus routine use of episiotomy

M. Macleod (Lead / Corresponding author), K. Goyder, L. Howarth, R. Bahl, B. Strachan, D. J. Murphy

    Research output: Contribution to journalArticle

    21 Citations (Scopus)

    Abstract


    Objective

    To 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.
    Design

    Longitudinal prospective cohort study embedded within a two-centre randomised controlled trial (RCT).
    Setting

    Two UK tertiary-level maternity units.
    Population

    Antenatally recruited participants of an RCT of restrictive versus routine use of episiotomy at OVD.
    Methods

    A self-completing questionnaire was administered antenatally, before hospital discharge, at 6 weeks and at 1 year postpartum.
    Main outcome measures

    Urinary and anal incontinence, dyspareunia, perineal pain and psychological morbidity.
    Results

    Longitudinal 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.
    Conclusions

    Morbidities 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.
    Original languageEnglish
    Pages (from-to)1020-1027
    Number of pages8
    JournalBJOG: An International Journal of Obstetrics & Gynaecology
    Volume120
    Issue number8
    DOIs
    Publication statusPublished - Jul 2013

    Fingerprint

    Episiotomy
    Postpartum Period
    Cohort Studies
    Randomized Controlled Trials
    Prospective Studies
    Morbidity
    Postpartum Depression
    Pain
    Psychology
    Dyspareunia
    Stress Urinary Incontinence
    Third Pregnancy Trimester
    Incidence

    Keywords

    • episiotomy
    • operative vaginal delivery
    • pelvic floor morbidity
    • RCT

    Cite this

    @article{427ca972ea254f08835cc7ee7bbbe12e,
    title = "Morbidity experienced by women before and after operative vaginal delivery: prospective cohort study nested within a two-centre RCT of restrictive versus routine use of episiotomy",
    abstract = "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.",
    keywords = "episiotomy, operative vaginal delivery, pelvic floor morbidity, RCT",
    author = "M. Macleod and K. Goyder and L. Howarth and R. Bahl and B. Strachan and Murphy, {D. J.}",
    year = "2013",
    month = "7",
    doi = "10.1111/1471-0528.12184",
    language = "English",
    volume = "120",
    pages = "1020--1027",
    journal = "BJOG: An International Journal of Obstetrics & Gynaecology",
    issn = "1470-0328",
    publisher = "Wiley",
    number = "8",

    }

    Morbidity experienced by women before and after operative vaginal delivery : prospective cohort study nested within a two-centre RCT of restrictive versus routine use of episiotomy. / Macleod, M. (Lead / Corresponding author); Goyder, K.; Howarth, L.; Bahl, R.; Strachan, B.; Murphy, D. J.

    In: BJOG: An International Journal of Obstetrics & Gynaecology, Vol. 120, No. 8, 07.2013, p. 1020-1027.

    Research output: Contribution to journalArticle

    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

    VL - 120

    SP - 1020

    EP - 1027

    JO - BJOG: An International Journal of Obstetrics & Gynaecology

    JF - BJOG: An International Journal of Obstetrics & Gynaecology

    SN - 1470-0328

    IS - 8

    ER -