[Maternal and neonatal consequences induced by the French recommendations for episiotomy practice. Monocentric study about 5409 vaginal deliveries] (original) (raw)
Related papers
Journal de gynécologie, obstétrique et biologie de la reproduction, 2010
To evaluate our practice following Clinical Practice Guidelines (CPG) of the French College of Obstetricians and Gynecologists (CNGOF) in 2005 advocating a policy of restrictive episiotomy and to show that a significative decrease in the rate of episiotomy does not increase the number of third and fourth degree perineal tears. A retrospective study of episiotomies and third/fourth degree perineal tears of the year 2003 (before the CPG) was compared with the year 2007 (after the CPG). We analyzed the indications of episiotomies and compared the rate of episiotomies and severe perineal tears between the two periods. In 2003, the rate of episiotomies was 18.8% (upon 1755 vaginal deliveries). We observed 16 (9 per thousand) third-degree perineal tears, five of which was associated with episiotomies; and two (1 per thousand) fourth-degree perineal tears. In 2007, the rate of episiotomies was 3.4% (upon 1940 vaginal deliveries). There were eight (4 per thousand) third-degree and four (2 p...
International Journal of Innovation and Applied Studies, 2014
The objective was to study the episiotomy and perineal tears in the service of Gynecology Obstetrics Health Centre Cherif Idrissi Kenitra the Gharb region. Analytical study on a sample of 327 women delivered. In this section, we have used standard statistical methods such as: chisquare test, calculating the coefficients of bond and to determine the factors that influence directly or indirectly on the practices of episiotomy, we adopted the analysis of logistic regression. This study has evaluated the rates and risks associated with the use of episiotomy and perineal tears. Respectively, an episiotomy 41.28% and a rate of perineal tears of 3.6%. In univariate analysis, four risk factors were associated with the occurrence of perineal tears; primiparity (8.1% vs 1.9%), the presentation of posterior release (21.4% vs 2.6%), episiotomy (5.9% vs 1.6%) and macrosomia (9 5 vs 2.5). Against by five factors were found as risk factors associated with the use of episiotomy, primiparity (60.5% vs 2% °, age class above the age of 21, the extraction sucker (62.5% vs 36.1%), the presentation of the previous release (42.5% vs 14.3%) and birth interval of less than 5 years (46.4% vs 18.3%). adjusted during the multivariate analysis only logistic regression primiparity and vacuum extraction were strongly associated with the use of episiotomy. If we can not recommend good thresholds of episiotomy, could act on these risk factors to the fetus or the mother are preventable, provided they are well taken care of throughout the early period ANC because this action is an element of great importance. But there are circumstances in which a prudent and appropriate clinical judgment dictate the obstetrician performing an episiotomy. It is obvious that preventive episiotomy is performed preferentially in situations of higher risk of tearing (large fetus fragile perineum, instrumental extraction ...).
Journal de gynécologie, obstétrique et biologie de la reproduction, 2010
In agreement with national guidelines published in 2007, limiting duration of expulsive efforts to 30 minutes is a common obstetrical practice in France. In many other countries, there is no fixed limit for pushing duration. The objective of our work is to analyze mode of delivery and neonatal issues according to duration of expulsive efforts. It is a secondary analysis of an observational prospective study, among low-risk primiparous women, in 138 French maternity units. According to duration of expulsive efforts, we determined proportions of spontaneous and instrumental vaginal deliveries. Then, we analyzed the risk of neonatal asphyxia (defined by pH <or=7.10 and/or 5-minute Apgar score <or=7) according to duration of expulsive efforts, with stratification on mode of delivery. Three thousand three hundred and thirty low-risk primiparous women were included. Median duration of expulsive efforts was 15 minutes and 18.5 % (n=602) of women pushed more than 30 minutes. Among wom...
2008
To compare two policies for episiotomy: restrictive and systematic. It is a quasi-randomised comparative study between two French university hospitals with contrasting episiotomy policies: one using it restrictively and the second routinely. Population included 774 nulliparous women delivered during 1996 of a singleton in cephalic presentation at a term of 37-41 weeks. A questionnaire was mailed four years after delivery. Sample size was calculated to allow showing a 10% difference in the prevalence of urinary incontinence with 80% power. Main outcome measures were urinary incontinence, anal incontinence, perineal pain and pain during intercourse. We received 627 responses (81%), 320 from women delivered under the restrictive policy, 307 from women delivered under the routine policy. In the restrictive group, 186 (49%) deliveries included mediolateral episiotomies and in the routine group, 348 (88%). Four years after the first delivery, the groups did not differ in the prevalence of urinary incontinence (26% versus 32%), perineal pain (6% versus 8%), or pain during intercourse (18% versus 21%). Anal incontinence was less prevalent in the restrictive group (11% versus 16%). The difference was significant for flatus (8% versus 13%) but not for faecal incontinence (3% for both groups). Logistic regression confirmed that a policy of routine episiotomy was associated with a risk of anal incontinence nearly twice as high as the risk associated with a restrictive policy (OR=1.84, 95 % CI :1.05-3.22). A policy of routine episiotomy does not protect against urinary or anal incontinence four years after first delivery.
Journal de gynécologie, obstétrique et biologie de la reproduction, 2014
To evaluate the perineal outcome after a major decrease in episiotomy rate in a high-risk (level III) maternity ward. This was a retrospective cohort study in a teaching high-risk maternity comparing perineal tears between 2003 and 2010. We included for analysis: pregnancies at 25 weeks or more, fetal birthweights of 500 g or more, vaginal deliveries in our maternity, singletons or multiple pregnancies, cephalic or breech presentations. The two populations were comparable. In 2003, we performed 18.8% of episiotomies and 1.3% in 2010. Between these years, our intact perineum rate increased from 28.8 to 37.5% (P<0.0001). We also report an increase in first and second degree perineum lesions (20.5% in 2003 and 40.2% in 2010, P<0.0001) and anterior perineal lesions (17.8% in 2003 and 30.3% in 2010, P<0.0001). We also report a significant decrease in perineal lesions with sphincter injuries (1% in 2003 and 0.3% in 2010 P<0.0001). Comparing 2003 to 2010, the majority of cases ...
[Regionalization of very preterm birth care sites in Ile-de France in 1998]
Santé publique (Vandoeuvre-lès-Nancy, France), 2003
The objective of this article is to describe the conditions under which very premature babies were born in the Paris region between June 1 and December 31, 1998, that is to say those born prior to reaching 33 weeks of term (SA) and/or having a birth weight less than 1500 grams. The study looked at all pre-term births, including medical terminations of pregnancy (TOP), occurring in one of the 135 maternity units in the Paris region. Between June 1 and December 31, 1998, 1337 mothers gave birth to babies prior to reaching 33 weeks of term (SA) and/or having a birth weight less than 1500 grams in 84 maternity units in the Paris region, 263 of which had a medical termination of pregnancy (20%). These mothers were older than average for the region (25% were 35 years old or older); 4.3% of them do not have social insurance coverage. The remaining 1074 mothers (excluding TOP) gave birth to 1290 children, of which 202 were stillbirths, 46 died in the labor ward and 1042 were admitted to a n...
Journal de gynécologie, obstétrique et biologie de la reproduction, 2012
Describe management of severe postpartum haemorrhages (PPH) and its compliance with national guidelines and identify determinants of non-optimal care. Population-based cohort study of 1379 women with severe PPH due to uterine atony after vaginal delivery, conducted in 106 French maternity units between December 2004 and November 2006. Severe PPH was defined by a peripartum haemoglobin drop of 4g/dL or more, blood loss of 1000 mL or more, hysterectomy, or transfer to intensive care for PPH. The frequency of each recommended procedure for the management of PPH was described. Associations between quality of care and both individual and institutional characteristics were assessed by univariate analysis and multivariate logistic regression. Management of severe PPH was not optimal in 65.9% of cases. The recommended components that were applied least often were administration of second line uterotonics, and transfusion of patients with a low haemoglobin. After adjustment for individual ch...
« Comment naissent les mères »? Expériences cliniques à la maternité de Genève
Therapie Familiale, 2006
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