Vacuum extraction: aRR 2.79 (95% CI ,2.73 to 2.86)
Forceps: aRR 4.27 (95% CI, 3.86 to 4.72)
High birthweight: aRR 2.61 (95% CI, 2.50 to 2.72)
Maternal characteristics that increased the risk of OASIS included
Increasing maternal age
Decreasing maternal height
Obesity (if no adjustment for fetal birthweight): aRR 1.04 (95% CI, 1.04 to 1.08)
The following were associated with a reduced risk of OASIS
Smoking: aRR 0.74 (95% CI, 0.70 to 0.79)
Lower maternal education: aRR 0.87 (95% CI, 0.83 to 0.92)
Previous cesarean section increased the risk of OASIS
aRR 1.41 (95% CI, 1.36 to 1.47)
The risk of OASIS was increased with primiparity, instrument-assisted delivery, high birthweight, increased maternal age, decreased maternal height, and previous cesarean
The authors state
A negative association with OASIS was seen with smoking and low maternal educational levels; however, there are uncertainties whether this association represents a true protective effect or a potential difference in the provision of health care
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