A prospective multicenter audit of labor-room episiotomy and anal sphincter injury assessment in the Netherlands

Abstract 

Objective

To assess the length and angle of mediolateral episiotomies performed by midwives and resident gynecologists at 3 teaching hospitals in the Netherlands, and determine the incidence of obstetric anal sphincter injury.

Methods

In this prospective audit conducted between February and September 2008, all women delivered at the 3 hospitals were examined in the labor room for perineal injury. When an injury was assessed as being grade 2 or higher, it was re-evaluated. The incidence of anal sphincter injury was then compared with that reported in the preceding year.

Results

Of 1979 women delivered, 420 (21.2%) were given an episiotomy and 58 (2.9%) sustained anal sphincter injury. The episiotomies formed a mean angle of 40° with the perineal midline. There was no difference in length or angle between the episiotomies performed by resident gynecologists and those performed by midwives, and the angle of most episiotomies was sufficiently wide. Compared with the preceding year, the rate of anal sphincter injury was significantly higher.

Conclusion

The quality of episiotomies did not differ when performed by midwives or resident gynecologists. To improve the recognition and classification of obstetric anal sphincter injuries, audits based on an internationally accredited classification could easily become a part of routine hospital practice.

Keywords: Assessment, Episiotomy, Obstetric anal sphincter injury