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.