Introduction
Methods
Identification of studies
Study selection and data extraction procedures
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Population: Women undergoing non instrumental vaginal birth
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Intervention: Mediolateral episiotomy (MLE)
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Comparator: No episiotomy or spontaneous perineal tear
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Outcome: Third or fourth degree perineal tears/ Obstetric anal sphincter injury (OASI).
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Study designs: All except case series or reports
Methodological quality assessment and data synthesis
Results
Author, year, country | Study design | Age | Sample size | Confounders in the study that were adjusted | Intervention | Control |
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Characteristics of articles included in the systematic review and meta- analysis
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Gurol- Urganci [1] 2013, UK | Retrospective Cohort study | 15-45 years | 1035253 | Ethnicity, Socio-economic deprivation measured using index of multiple deprivation, Prolonged labour, Birth-weight | Mediolateral episiotomy (MLE) | Spontaneous vaginal tear |
Prager [30] 2008, Sweden | Retrospective cohort study | 25- >/= 42 years | 2000 | Birthweight, duration of second stage, use of oxytocin, perineal protection technique | MLE | Women who had no episiotomy |
Bodner-Adler[31] 2004, Austria | Retrospective cohort study | Median age at delivery 26 years | 725 | Use of oxytocin, epidural analgesia, maternal position at delivery, length of first and second stage of labour, birth weight | MLE | No control |
Buekens [32] 1985, Belgium | Observational cohort study | Not mentioned | 21278 | Birthweight , parity | Mediolateral episiotomy | Women without episiotomy |
Lam [33]2006, Hong Kong | Retrospective cohort study | Mean – 29 years | 6222 (3312 primiparous and 2910 multiparous) | No other risk factors were taken into account apart from parity | Mediolateral episiotomy | Spontaneous vaginal tears |
Samarasekera [24] 2009, UK | Retrospective cohort study All women who suffered third degree tears between 1981-1993 found through delivery records | Mean 26.9 years | 125 (54 – had third degree tears, 71 – had an uncomplicated vaginal delivery) | Birth weight, length of second stage, maternal age, parity | .(MLE data extracted) | Women who had an uncomplicated vaginal delivery during 1981 – 1993 |
Steiner [34] 2012, Israel | Retrospective cohort study | Not mentioned | 168,077 | Confounders controlled for macrosomia, non-reassuring fetal heart rate, occipito -posterior position and shoulder dystocia | MLE | Without episiotomy |
Characteristics of articles included in the systematic review
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Andrews [35] 2006, UK | Retrospective cohort study | Not mentioned | 241 | Confounding factors not adjusted | MLE | No control |
Jango, [11] 2013, Denmark | Retrospective Cohort study | Median – 28 years | 214256 | Birth weight, epidural, Induction of labour, Oxytocin augmentation | MLE | No control |
Baghestan[36] 2010, Norway | Retrospective cohort study | Mean – 24 years | 1,673,442 | Maternal age, birth-order, Previous caesarean birth, birth weight, ethnicity, induction of labour, analgesia | Mediolateral episiotomy | No control |
Ampt[37] 2013, Australia | Retrospective cohort study | 20- 40 years | 528,846 | Confounding factors were not adjusted | Mediolateral episiotomy | No control |
Revicky [8] 2010, UK | Retrospective cross sectional study | 20- 41 years | 10314 | Type of augmentation, epidural, Birth weight | MLE | No episiotomy |
Shihadeh [38] 2001, Jordan | Retrospective cohort study | Not mentioned | 17559 (Primiparous = 3875, Multip = 13684) | To avoid confounding factors, the study analysed a sub sample which included vertex vaginal deliveries and stratified further based on birthweight | MLE | Without episiotomy |
Angioli[39] 2000, USA | Retrospective cohort study | Mean 25.5 +/- 6.4 years | Primiparous 19360 Multip - 30850 | Ethnicity, birth weight, maternal age , parity | MLE data extracted | No control |
Mora-Hervas [40] 2015, Spain | Cohort study | Not mentioned | 938 | Not mentioned | MLE | Spontaneous vaginal tears |
Twidale, [23] 2013, Australia | Retrospective cohort study | Not mentioned | 7314 | Birth weight, epidural, induction of labour | MLE | No control |
STUDY | SELECTION | Comparability | Outcome | SCORE (out of 13) | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Representativeness | Selection of non-exposed cohort | Ascertainment of exposure | Outcomes of interest | Controls | Additional factors | Assessment of outcome | Follow-up | Adequacy of follow-up | ||
Gurol-Urganci[1] 2013 | * | x | * | * | * | x | * record linkage | x | x | 5 |
Prager[30] 2008 | * | x | * | * | * | * | * record linkage | x | x | 6 |
Bodner- Adler [31] | * | x | * | * | * | * | * | x | x | 5 |
Buekens[32] 1985 | * | x | * | * | * | * | * | x | x | 6 |
Lam [33] 2006 | * | * | * | * | * | x | * record linkage | x | x | 6 |
Samarasekera,[24] 2009 | * | * | * | * | * | * | * | * | x | 8 |
Steiner[34] 2012 | * | * | * | * | * | * | * | x | x | 7 |
Andrews[35], 2006 | * | x | * | * | x | x | * | x | x | 4 |
Jango [11] 2013 | * | * | * | * | * | * | * | x | x | 7 |
Baghestan[36] 2010 | * | * | * | * | * | * | * | x | x | 7 |
Ampt,[37] 2013 | * | x | * | * | * | * | * | x | x | 6 |
Revicky, [8] 2010 | * | x | * | * | * | * | * | x | x | 6 |
Shihadeh,[38] 2001 | * | * | * | * | * | * | * | x | x | 7 |
Angioli, [39] 2000 | * | * | * | * | * | * | * | x | x | 7 |
Mora-Hervas [40] 2015 | * | * | * | * | * | x | * | * | x | 7 |
Twidale, [23] 2013 | * | x | * | * | * | * | * | x | x | 6 |