Clinical evaluation of early postpartum pain and healing outcomes after mediolateral versus lateral episiotomy

Karbanová, Jaroslava; Rušavý, Zdeněk; Betincova, Lucie; Jansová, Magdalena; Necesalova, Pavlina; Kališ, Vladimír

doi:10.1016/j.ijgo.2014.05.025

Cited by 21 publications

(28 citation statements)

References 25 publications

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“…activities of daily living, and amount of analgesic use. The authors found no significant differences in overall pain scores from any rating system or in the amount of analgesics used (38). These findings are in compliance with and support the observational study findings in Paper I and Paper II, comparing different episiotomy techniques and perineal pain perception the first day after delivery and at 3 months postpartum.…”

Section: Perineal Painsupporting

confidence: 82%

Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study

2012

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Section: Perineal Painsupporting

confidence: 82%

Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study

2012

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“…More space also allows for instrumentation of assisted deliveries by forceps or vacuums (Cargill 2004; Murphy 2008a). At other times, episiotomy is performed to shorten second stage of labour for various maternal and fetal indications (Hamilton 1861; Hartmann 2005) such as maternal exhaustion and fetal bradycardia.…”

Section: Introductionmentioning

confidence: 99%

Selective versus routine use of episiotomy for vaginal birth

Jiang

Qian

Carroli

et al. 2017

Cochrane Database of Systematic Reviews

318

340

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Background Some clinicians believe that routine episiotomy, a surgical cut of the vagina and perineum, will prevent serious tears during childbirth. On the other hand, an episiotomy guarantees perineal trauma and sutures. Objectives To assess the effects on mother and baby of a policy of selective episiotomy ('only if needed') compared with a policy of routine episiotomy ('part of routine management') for vaginal births. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register (14 September 2016) and reference lists of retrieved studies. Selection criteria Randomised controlled trials (RCTs) comparing selective versus routine use of episiotomy, irrespective of parity, setting or surgical type of episiotomy. We included trials where either unassisted or assisted vaginal births were intended. Quasi‐RCTs, trials using a cross‐over design or those published in abstract form only were not eligible for inclusion in this review. Data collection and analysis Two authors independently screened studies, extracted data, and assessed risk of bias. A third author mediated where there was no clear consensus. We observed good practice for data analysis and interpretation where trialists were review authors. We used fixed‐effect models unless heterogeneity precluded this, expressed results as risk ratios (RR) and 95% confidence intervals (CI), and assessed the certainty of the evidence using GRADE. Main results This updated review includes 12 studies (6177 women), 11 in women in labour for whom a vaginal birth was intended, and one in women where an assisted birth was anticipated. Two were trials each with more than 1000 women (Argentina and the UK), and the rest were smaller (from Canada, Germany, Spain, Ireland, Malaysia, Pakistan, Columbia and Saudi Arabia). Eight trials included primiparous women only, and four trials were in both primiparous and multiparous women. For risk of bias, allocation was adequately concealed and reported in nine trials; sequence generation random and adequately reported in three trials; blinding of outcomes adequate and reported in one trial, blinding of participants and personnel reported in one trial. For women where an unassisted vaginal birth was anticipated, a policy of selective episiotomy may result in 30% fewer women experiencing severe perineal/vaginal trauma (RR 0.70, 95% CI 0.52 to 0.94; 5375 women; eight RCTs; low‐certainty evidence). We do not know if there is a difference for blood loss at delivery (an average of 27 mL less with selective episiotomy, 95% CI from 75 mL less to 20 mL more; two trials, 336 women, very low‐certainty evidence). Both selective and routine episiotomy have little or no effect on infants with Apgar score less than seven at five minutes (four trials, no events; 3908 women, moderate‐certain...

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“…According to previous research [5,8,9], approximately 70% of the patients suffered from perineal pain due to an episiotomy at D7 postpartum. To show a relative reduction of at the least 30% in this incidence in the ropivacaine arm, with 90% power at the 5% level of signi cance, and a bilateral test, the study requires 124 women with episiotomy in each group.…”

Section: Sample Sizementioning

confidence: 99%

“…Perineal pain is a common consequence of episiotomy and affects up to 97% of women on day 1 postpartum [5,6], up to 70% of women at day 7 to 10 postpartum [7][8][9] and may persist until at least 5 months postpartum [10,11]. Pain after perineal wound (apart from episiotomy) are also reported but less studied because of the high variability of the localization and the depth of the tear.…”

Section: Introductionmentioning

confidence: 99%

Ropivacaine 75mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women- The ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trial.

Cardaillac

Ploteau

Thuaut

et al. 2020

Preprint

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Background Perineal pain due to episiotomy is commonly reported and can be severe enough to disturb the mother-infant dyad during the postpartum period. Its incidence at day 7 postpartum varies from 63% to 74%. Recent studies have already investigated the analgesic efficacy of perineal infiltration of ropivacaine after episiotomy, but have only focused on the immediate postpartum period (at 24 and 48 hours after birth). Large, adequately powered, multicenter, randomized controlled trials are required to evaluate the impact of ropivacaine infiltration on perineal pain and mid- and long-term quality of life before the widespread use of ropivacaine to prevent perineal pain after episiotomy can be recommended. Methods The ROPISIO study is a two-center, randomized, double-blind, placebo-controlled trial in La Roche sur Yon and Nantes, France. It will involve 272 women with vaginal singleton delivery and mediolateral episiotomy at term (≥ 37 weeks). Perineal infiltration (ropivacaine 75mg or placebo) will be administrated just after vaginal birth and before episiotomy repair. The primary outcome will be the analgesic efficacy at day 7 postpartum (mid-term), defined by the numerical rating scale of pain (ENS NRS) strictly superior to 3/10 on the perineal repair area. Secondary outcomes will be the analgesic efficacy (ENS NRS), the impact of pain on daily behavior, on the quality of life (36-Item Short Form Health Survey), on the occurrence of symptoms of postpartum depression (Edinburgh Postnatal Depression Scale) and on sexuality (Female Sexual Function Index) at 3 and 6 months (long-term) using validated online questionnaires. This study will have 90% power to show approximately 30% relative risk reduction in the incidence of perineal pain at day 7, from 70.0% to 50.0%. Discussion Ropivacaine is a promising candidate drug, inexpensive, easy to administer, and would be suitable to include in the routine management of deliveries in labor ward. This study will investigate if perineal ropivacaine infiltration just after birth can reduce mid- and long-term postpartum pain and increase quality of life in women with mediolateral episiotomy.

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Clinical evaluation of early postpartum pain and healing outcomes after mediolateral versus lateral episiotomy

Abstract: Incidence and extent of pain in the first 10 days after LE correspond to those after adequately performed MLE.

Cited by 21 publications

References 25 publications

Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study

Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study

Selective versus routine use of episiotomy for vaginal birth

Ropivacaine 75mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women- The ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trial.

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