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Purpose <p>This study aimed to evaluate whether episiotomy reduces obstetric anal sphincter injuries (OASIS) rates in nulliparous women with a second stage of labor lasting ≥ 3&#xa0;h.</p> Methods <p>This retrospective study focused on nulliparous women at ≥ 36&#xa0;weeks of gestation with singleton pregnancies who experienced a second stage of labor lasting ≥ 3&#xa0;h and ultimately achieved spontaneous, non-operative, vaginal delivery between 2014 and 2024. Participants were categorized into two groups based on their episiotomy status. The primary outcome was the occurrence of OASIS, namely third- and fourth-degree perineal lacerations.</p> Results <p>The study included 1164 (58.3%) women who underwent episiotomy and 831 (41.7%) who did not. Women in the episiotomy group were significantly younger (27.79 ± 4.31 vs. 28.47 ± 4.51&#xa0;years, p &lt; 0.001), had a higher prevalence of hypertensive disorders (7.7% vs. 5.2%, p = 0.029), experienced a slightly longer second stage of labor (3.62 ± 0.4 vs. 3.53 ± 0.4&#xa0;h, p &lt; 0.001), and delivered newborns with higher birthweight (3366 ± 390 vs. 3284 ± 376&#xa0;g, p &lt; 0.001). The OASIS rates were comparable between the groups (1.9% vs. 2.2%, p = 0.82), consistent across all subtypes and in a subanalysis of women with a second stage of ≥ 4&#xa0;h (2.9% vs. 2.5%, p = 0.59). In adjusted multivariable analysis, episiotomy was not associated with OASIS (adjusted OR 0.95, 95% CI 0.48–1.84).</p> Conclusion <p>In nulliparous women with spontaneous vaginal delivery and a prolonged second stage (≥ 3&#xa0;h), episiotomy was not associated with a reduced risk of OASIS, even when the second stage exceeded 4&#xa0;h. Our findings support existing guidelines that advocate against routine episiotomy in this population.</p>

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Episiotomy and the risk of obstetric anal sphincter injury in nulliparous women with a prolonged second stage

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月29日

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  • Gal Bachar,
  • Shahar Rosenthal,
  • Nira Gridish,
  • Naphtali Justman,
  • Nizar Khatib,
  • Ido Solt,
  • Yaniv Zipori

摘要

Purpose

This study aimed to evaluate whether episiotomy reduces obstetric anal sphincter injuries (OASIS) rates in nulliparous women with a second stage of labor lasting ≥ 3 h.

Methods

This retrospective study focused on nulliparous women at ≥ 36 weeks of gestation with singleton pregnancies who experienced a second stage of labor lasting ≥ 3 h and ultimately achieved spontaneous, non-operative, vaginal delivery between 2014 and 2024. Participants were categorized into two groups based on their episiotomy status. The primary outcome was the occurrence of OASIS, namely third- and fourth-degree perineal lacerations.

Results

The study included 1164 (58.3%) women who underwent episiotomy and 831 (41.7%) who did not. Women in the episiotomy group were significantly younger (27.79 ± 4.31 vs. 28.47 ± 4.51 years, p < 0.001), had a higher prevalence of hypertensive disorders (7.7% vs. 5.2%, p = 0.029), experienced a slightly longer second stage of labor (3.62 ± 0.4 vs. 3.53 ± 0.4 h, p < 0.001), and delivered newborns with higher birthweight (3366 ± 390 vs. 3284 ± 376 g, p < 0.001). The OASIS rates were comparable between the groups (1.9% vs. 2.2%, p = 0.82), consistent across all subtypes and in a subanalysis of women with a second stage of ≥ 4 h (2.9% vs. 2.5%, p = 0.59). In adjusted multivariable analysis, episiotomy was not associated with OASIS (adjusted OR 0.95, 95% CI 0.48–1.84).

Conclusion

In nulliparous women with spontaneous vaginal delivery and a prolonged second stage (≥ 3 h), episiotomy was not associated with a reduced risk of OASIS, even when the second stage exceeded 4 h. Our findings support existing guidelines that advocate against routine episiotomy in this population.