title: Restricted episiotomy use and maternal and neonatal injuries: a retrospective cohort study.
abstract: There is relatively little information on episiotomies in the context of restricted episiotomy use. This study sought to examine maternal and neonatal injuries with restricted episiotomy use.
  
  
  
  We performed a retrospective database analysis of vaginal deliveries at a tertiary care maternity hospital from June 2010 to June 2015. Maternal injuries (third- or fourth-degree lacerations) and neonatal injuries (birth trauma) were identified through the International Classification of Diseases, Ninth Revision, codes. Vaginal deliveries were classified as spontaneous, vacuum-assisted, or forceps-assisted. The associations between episiotomy and maternal and neonatal injuries were examined with stratification by parity, type of vaginal delivery, and type of episiotomy (midline or mediolateral). Adjusted-odds' ratios were calculated for maternal and neonatal injuries using a multiple logistic regression model to adjust for potential confounders.
  
  
  
  22,800 deliveries occurred during the study interval involving 23,016 neonates. The episiotomy rate was 6.7 % overall and 22.9 % in operative vaginal deliveries. Episiotomies, both midline and mediolateral, were associated with increased risks of maternal and neonatal injuries regardless of parity (p < 0.0001). Upon stratification by the type of delivery, the association with maternal injury remained only for spontaneous vaginal deliveries (p < 0.0001). Adjusted-odds' ratios demonstrated a continued association between episiotomy and maternal [aOR 1.67 (1.39-2.05)] and neonatal injuries [aOR 1.43 (1.17-1.73)].
  
  
  
  Episiotomy continues to be associated with increased third- and fourth-degree lacerations with restricted use, particularly in spontaneous vaginal deliveries.
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii, 1319 Punahou Street, #824, Honolulu, HI, 96826, USA. kyamasat@hawaii.edu.
authors.forename: Kelly
authors.identifier: 0000-0003-1730-6324
authors.initials: K
authors.lastname: Yamasato
authors.affiliation: Hawaii Pacific Health Patient Safety and Quality Services, Honolulu, HI, USA.
authors.forename: Chieko
authors.initials: C
authors.lastname: Kimata
authors.affiliation: Hawaii Pacific Health Patient Safety and Quality Services, Honolulu, HI, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Huegel
authors.affiliation: Hawaii Pacific Health Patient Safety and Quality Services, Honolulu, HI, USA.
authors.forename: Marsha
authors.initials: M
authors.lastname: Durbin
authors.affiliation: Hawaii Pacific Health Patient Safety and Quality Services, Honolulu, HI, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Ashton
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii, 1319 Punahou Street, #824, Honolulu, HI, 96826, USA.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Burlingame
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000209:etiology*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004841:Episiotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Birth injuries; Delivery; Episiotomy; Lacerations; Obstetric