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News
The cut that makes a difference: A large study found that mediolateral episiotomy reduces the risk of obstetric anal sphincter injury (OASI) by 40–46% in patients without prior vaginal delivery undergoing operative vaginal delivery. Midline episiotomy, by contrast, more than doubles—or even quadruples—that risk depending on delivery method and history. The findings strongly favor mediolateral over midline technique.
A secondary analysis of over 5,200 patients from a large U.S. multicenter cohort found that the type of episiotomy performed during operative vaginal delivery (OVD) dramatically affects the risk of obstetric anal sphincter injury (OASI)—one of the most serious complications of childbirth. Mediolateral episiotomy was associated with a 40–46% reduction in OASI risk for patients without a prior vaginal delivery, while midline episiotomy was linked to significantly increased risk across multiple delivery scenarios.
The study, published in Obstetrics & Gynecology and led by Dr. Alexis A. Doyle of the University of Utah Health, analyzed patients who underwent either vacuum-assisted or forceps-assisted vaginal delivery. Overall, OASI occurred in 20.1% of patients—and those who received any episiotomy had higher overall odds of OASI compared to those who didn't, underscoring that technique selection is critical.
Why it matters: OASI can lead to long-term complications including fecal incontinence and pelvic floor dysfunction. These findings offer clear, actionable guidance for clinicians: when episiotomy is needed during operative vaginal delivery, the mediolateral technique should be strongly preferred—especially for patients without a prior vaginal delivery.
