[Evaluating a policy of restrictive episiotomy before and after practice guidelines by the French College of Obstetricians and Gynecologists] (original) (raw)
Related papers
2009
Recommendations for clinical practice (RPC) edited by the College of French gynecologists and obstetricians (CNGOF) claim for a more restrictive use of episiotomy. The aims of this study were to assess the impact of these recommendations on episiotomy practice and to evaluate maternal and neonatal outcomes of a more restrictive approach. We compared in a retrospective analysis episiotomy practice, maternal and neonatal consequences of a restrictive episiotomy policy between 2004 and 2006 (before and after recommendations publication) in a level III maternity unit. Identification of risks factors for episiotomy practice in our population was based on a multivariate analysis. Two thousand and five hundred and 2909 patients who delivered vaginally respectively in 2004 and 2006 were included. In 2006, fewer episiotomies were performed (43.48% vs 32.32%, p<0.0001) and more grade I and II perineal tears occurred (27.56% vs 36.61%, p=0.0001) whereas the anal sphincter tear rate remained constant (0.48% vs 0.69%, p=0.376). Neonatal condition assessed by the Apgar score was also stable. In multivariate analysis, risk factors for episiotomy already described in the literature were significant in our study and year 2006 was associated with less use of episiotomy in comparison with year 2004 (OR: 0.499; IC: 0.44-0.57; p<0.0001). In our institution, French guidelines were followed by a reduction in the use of episiotomy practice without increasing the risk for severe perineal tear or neonatal distress.
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 ...).
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 ...
Gynécologie Obstétrique & Fertilité, 2007
Objectif.-Décrire l'influence respective de l'équipe obstétricale et de la patiente sur le choix de la voie d'accouchement en cas de présentation du siège à terme. Patientes et méthodes.-Cette étude rétrospective a inclus toutes les patientes ayant accouché à terme d'un foetus unique en présentation du siège entre janvier 1998 et décembre 2004 dans une maternité de niveau 3. Toutes avaient fait l'objet d'une évaluation préalable par un score regroupant cinq critères : âge maternel, parité, antécédents obstétricaux, radiopelvimétrie et confrontation céphalopelvienne. L'obstétricien était libre de suivre ou non les indications proposées par le score et devait recueillir le consentement de la patiente après information. Nous avons recueilli le mode d'accouchement et différents paramètres néonatals. Résultats.-Parmi les 200 cas recensés, le taux de césarienne s'est significativement élevé au fil du temps (de 52 % en 1998 à 80 % en 2004 [p = 0,002]) alors que l'état néonatal et la proportion de scores favorables n'étaient pas statistiquement différents. Cette augmentation du recours à la césarienne est surtout induite par le refus croissant de la voie vaginale par la patiente (p = 0,001) tandis que la tendance au refus par l'équipe obstétricale n'est pas significative (p = 0,3). Discussion et conclusion.-L'augmentation du recours à la césarienne en cas de présentation du siège dans une équipe disposant d'une évaluation systématique préalable repose surtout sur le refus de la patiente de la voie vaginale. Ce changement de pratique ne s'accompagne pas d'une amélioration de l'état néonatal.