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Sökning: WFRF:(Kallner Helena Kopp) > Lateral episiotomy ...

LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00005813naa a2200469 4500
001oai:DiVA.org:umu-227328
003SwePub
008240702s2024 | |||||||||||000 ||eng|
009oai:prod.swepub.kib.ki.se:238886011
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-2273282 URI
0247 a https://doi.org/10.1136/bmj-2023-0790142 DOI
0247 a http://kipublications.ki.se/Default.aspx?queryparsed=id:2388860112 URI
040 a (SwePub)umud (SwePub)ki
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Bergendahl, Sandrau Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden4 aut
2451 0a Lateral episiotomy or no episiotomy in vacuum assisted delivery in nulliparous women (EVA) :b multicentre, open label, randomised controlled trial
264 1b BMJ Publishing Group Ltd,c 2024
338 a electronic2 rdacarrier
520 a Objective: To assess the effect of lateral episiotomy, compared with no episiotomy, on obstetric anal sphincter injury in nulliparous women requiring vacuum extraction. Design: A multicentre, open label, randomised controlled trial.Setting: Eight hospitals in Sweden, 2017-23.Participants: 717 nulliparous women with a single live fetus of 34 gestational weeks or more, requiring vacuum extraction were randomly assigned (1:1) to lateral episiotomy or no episiotomy using sealed opaque envelopes. Randomisation was stratified by study site.Intervention: A standardised lateral episiotomy was performed during the vacuum extraction, at crowning of the fetal head, starting 1-3 cm from the posterior fourchette, at a 60° (45-80°) angle from the midline, and 4 cm (3-5 cm) long. The comparison was no episiotomy unless considered indispensable.Main outcome measures: The primary outcome of the episiotomy in vacuum assisted delivery (EVA) trial was obstetric anal sphincter injury, clinically diagnosed by combined visual inspection and digital rectal and vaginal examination. The primary analysis used a modified intention-to-treat population that included all consenting women with attempted or successful vacuum extraction. As a result of an interim analysis at significance level P<0.01, the primary endpoint was tested at 4% significance level with accompanying 96% confidence interval (CI).Results: From 1 July 2017 to 15 February 2023, 717 women were randomly assigned: 354 (49%) to lateral episiotomy and 363 (51%) to no episiotomy. Before vacuum extraction attempt, one woman withdrew consent and 14 had a spontaneous birth, leaving 702 for the primary analysis. In the intervention group, 21 (6%) of 344 women sustained obstetric anal sphincter injury, compared with 47 (13%) of 358 women in the comparison group (P=0.002). The risk difference was -7.0% (96% CI -11.7% to -2.5%). The risk ratio adjusted for site was 0.47 (96% CI 0.23 to 0.97) and unadjusted risk ratio was 0.46 (0.28 to 0.78). No significant differences were noted between groups in postpartum pain, blood loss, neonatal outcomes, or total adverse events, but the intervention group had more wound infections and dehiscence.Conclusions: Lateral episiotomy can be recommended for nulliparous women requiring vacuum extraction to significantly reduce the risk of obstetric anal sphincter injury. Trial registration: ClinicalTrials.gov NCT02643108.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Reproduktionsmedicin och gynekologi0 (SwePub)302202 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Obstetrics, Gynaecology and Reproductive Medicine0 (SwePub)302202 hsv//eng
7001 a Jonsson, Mariau Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden4 aut
7001 a Hesselman, Susanneu Department of Women's and Children's Health, Centre for Clinical Research Dalarna, Falun, Sweden4 aut
7001 a Ankarcrona, Victoriau Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden4 aut
7001 a Leijonhufvud, Åsau Department of Clinical Science Helsingborg, Lund University, Helsingborg, Sweden4 aut
7001 a Wihlbäck, Anna-Carinu Umeå universitet,Obstetrik och gynekologi4 aut0 (Swepub:umu)anawik97
7001 a Wallström, Toveu Department of Clinical Science and Education, South General Hospital, Karolinska Institutet, Stockholm, Sweden4 aut
7001 a Rydström, Emmieu Department of Obstetrics and Gynecology, Växjö Central Hospital, Växjö, Sweden4 aut
7001 a Friberg, Hannau Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden4 aut
7001 a Kopp Kallner, Helenau Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden4 aut
7001 a Brismar Wendel, Sophiau Karolinska Institutet,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden4 aut
7102 a Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Swedenb Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden4 org
7730 t BMJ. British Medical Journald : BMJ Publishing Group Ltdg 385, s. e079014-q 385x 0959-8146x 0959-535X
7730 t BMJ (Clinical research ed.)d : BMJ Publishing Group Ltdg 385, s. e079014-q 385<e079014-x 1756-1833
8564 u https://doi.org/10.1136/bmj-2023-079014y Fulltext
8564 u https://umu.diva-portal.org/smash/get/diva2:1880773/FULLTEXT01.pdfx primaryx Raw objecty fulltext:print
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-227328
8564 8u https://doi.org/10.1136/bmj-2023-079014
8564 8u http://kipublications.ki.se/Default.aspx?queryparsed=id:238886011

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