Low volume forceps practice and anal sphincter injury rate

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Complications

Background:

• Historically, forceps use was linked to high rates of severe perineal tears.
• In contemporary practice, forceps utilization is low, necessitating updated research on associated complications.
• Obstetric anal sphincter injury (OASIS) remains a significant concern during childbirth.

Purpose of the Study:

• To identify factors associated with obstetric anal sphincter injury (OASIS).
• To investigate OASIS occurrence in obstetric units with low forceps utilization.
• To analyze risk factors for OASIS in forceps-assisted deliveries.

Main Methods:

• Retrospective cohort study at two tertiary medical centers.
• Analysis of 764 singleton pregnancies delivered via forceps between 2011 and 2019.
• Comparison of women with and without OASIS following forceps delivery.

Main Results:

• The overall rate of OASIS was 2.5% (19 cases).
• Gestational diabetes mellitus and induction of labor were more common in the OASIS group.
• Sequential forceps use (after failed vacuum) was strongly associated with OASIS (OR 6.4, p<0.001) and remained the sole independent predictor in multivariate analysis (OR 4.7, p=0.02).

Conclusions:

• The incidence of OASIS in this low-volume forceps practice cohort was low.
• Sequential forceps use is the primary determinant of OASIS occurrence.
• Clinical practice should focus on minimizing sequential forceps use to reduce OASIS rates.