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This risk is increased with operative vaginal deliveries (OVDs), particularly forceps. However, there is conflicting evidence supporting the use of mediolateral\/lateral episiotomy (MLE\/LE) with OVD. The aim of this study was to assess whether MLE\/LE affects the incidence of OASI in OVD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Electronic searches were performed in OVID Medline, Embase and the Cochrane Library. Randomised and non-randomised observational studies investigating the risk of OASI in OVD with\/without MLE\/LE were eligible for inclusion. Pooled odds ratios (OR) were calculated using Revman 5.3. Risk of bias of was assessed using the Cochrane RoB2 and ROBINS-I tool. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 703,977 patients from 31 studies were pooled for meta-analysis. MLE\/LE significantly reduced the rate of OASI in OVD (OR 0.60 [95% CI 0.42\u20130.84]). On sub-group analysis, MLE\/LE significantly reduced the rate in nulliparous ventouse (OR 0.51 [95% CI 0.42\u20130.84]) and forceps deliveries (OR 0.32 [95% CI 0.29\u20130.61]). In multiparous women, although the incidence of OASI was lower when a ventouse or forceps delivery was performed with an MLE\/LE, this was not statistically significant. Heterogeneity remained significant across all studies (I\n                      <jats:sup>2<\/jats:sup>\n                      &gt; 50). The quality of all evidence was downgraded to \u201cvery low\u201d because of the critical risk of bias across many studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MLE\/LE may reduce the incidence of OASI in OVDs, particularly in nulliparous ventouse or forceps deliveries. This information will be useful in aiding clinical decision-making and counselling in the antenatal period and during labour.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00192-022-05145-1","type":"journal-article","created":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T03:03:26Z","timestamp":1649991806000},"page":"1393-1405","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Mediolateral\/lateral episiotomy with operative vaginal delivery and the risk reduction of obstetric anal sphincter injury (OASI): A systematic review and meta-analysis"],"prefix":"10.1007","volume":"33","author":[{"given":"Nicola Adanna","family":"Okeahialam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ka Woon","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swati","family":"Jha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul H.","family":"Sultan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5279-141X","authenticated-orcid":false,"given":"Ranee","family":"Thakar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,15]]},"reference":[{"key":"5145_CR1","doi-asserted-by":"publisher","unstructured":"Murphy D, Strachan B, Bahl R, the Royal College of Obstetricians and Gynaecologists. 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