Speksnijder L, et al. - In this prospective observational cohort study, researchers assessed the connection of mediolateral episiotomy with levator injury (levator avulsion, ballooning or combined) and urogynecological complaints. In women with a spontaneous vaginal delivery who did not obtain an anal sphincter injury, mediolateral episiotomy was not related to the occurrence of levator injury or urogynecological complaints. Findings suggested an association of levator injury with a prolonged second stage of labor and a non-occiput anterior fetal position.

Methods

• In a general hospital between 2012 and 2015, this investigation was performed in 204 primiparous women with a spontaneous vaginal delivery without anal sphincter tear.
• Out of 204 primiparous women, 103 had a mediolateral episiotomy.
• After delivery, validated urogynecological questionnaires and transperineal 3D/4D ultrasound were completed.
• Levator avulsion, ballooning (hiatal area of more than 25 cm²) and urogynecological questionnaire scores were outcome measures.
• Using univariate and multiple logistic regression analysis, statistical analysis was performed.

Results

• Thirteen months (range 6-33) was the median time at investigation after vaginal delivery.
• Researchers identified levator injury (avulsion, ballooning or combined) in 35 (40.0%) of the 103 women who had undergone mediolateral episiotomy and 33 (32.7%) of the 101 women without episiotomy (p=0.69).
• They did not find differences in the incidence of levator avulsion 27 (26.7%) vs 23 (22.8%), p=0.53) or in levator ballooning (20 (19.4%) vs 23 (22.8%), p=0.58) between both groups.
• An association was found between longer duration of the second stage of labor and the incidence of levator avulsion (OR 1.24 (95% CI 1.01- 1.52).
• Findings revealed that non-occiput anterior fetal position increased the risk of levator ballooning and levator injury (OR 10.19 (95% CI 1.89- 54.91) and OR 12.16 (95% CI 1.41- 104.38), respectively).
• No differences were found in urogynecological complaints.