Obstetric anal sphincter injuries during instrumental vaginal delivery
It gives us great pleasure to read the article titled “Obstetric anal sphincter injuries during instrumental vaginal delivery: An observational study based on 18-years of real-world data” by Fodstad K, et al1. We appreciate the great effort taken by the authors to meticulously extract the huge population based real world data of 70,783 women collected during the 18-years period from 2001-2018.
Nulliparous women undergoing instrumental vaginal delivery either through forceps or vacuum were studied and the incidence of obstetric anal sphincter injuries (OASIS) were noted. The data was also compared by making six 3-year time periods. However, we would like to enquire regarding a few finer points which will help to comprehend the study better.
On a careful notice, it was observed that the incidence of Forceps delivery without an episiotomy has increased from 2012 onwards. Royal College of Obstetricians and Gynecologists (RCOG) has already recommended the use of prophylactic episiotomy in patients undergoing forceps delivery. However, we presume that the prevailing country protocol in Norway of not using routine episiotomy would have helped to bring out this figure. Also, results from this study suggested that there was 49% reduction in OASIS after forceps and 51% decline after vacuum deliveries respectively. So, we would like to enquire the authors whether routine episiotomy should be recommended in all ventouse delivery as well.
It is also noticed that there was an absolute decrease in the prevalence of instrumental vaginal delivery (IVD) from 2001 to 2018. Was it due to an increase in the number of cesarean deliveries in which case there is a need to revive the art of IVD2. The third table in the original study has depicted an inverse relationship between age and incidence of OASIS. It will be highly appreciated if a clarity is obtained regarding the same.
The study limitation also mentioned that the registry data had been pre-validated. We would be greatly obliged if some light is thrown into this aspect. Nevertheless, the great effort on their part is highly appreciated.