Episiotomy and perineal tears presumed to be imminent: randomized controlled trial

Dannecker, Christian; Hillemanns, Peter; Strauß, Alexander; Hasbargen, Uwe; Hepp, H.; Anthuber, C.

doi:10.1111/j.0001-6349.2004.00366.x

Cited by 56 publications

(68 citation statements)

References 17 publications

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“…(14) An investigation conducted in Germany compared two proposals of episiotomy use in primip-arous women who underwent spontaneous vaginal delivery and vacuum extraction delivery: (1) restricted use (only for fetal indication) and (2) liberal use (both fetal indication and eminent perineal laceration); the study found no difference in hemoglobin variation between the pre and postpartum periods between women managed according to either of the two proposals. (15) Episiotomy and perineal trauma repair are the two surgical procedures most conducted by obstetricians. In Brazil the episiotomy rate is 71.6%, although current efforts aim to reduce it to 10%.…”

Section: Discussionmentioning

confidence: 99%

Análise da hemorragia no parto vaginal pelos índices de eritrócitos e hematócrito

et al. 2014

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Objective: To analyze hemorrhage at vaginal delivery using hemoglobin and hematocrit indices. Methods: This was a cross-sectional study of 328 vaginal deliveries divided into spontaneous delivery with or without episiotomy and forceps delivery. The sample was randomly stratified by type of vaginal delivery. Data were collected at admission for delivery, hospital discharge and postpartum return visit. Results: There were 122 (37.2%) deliveries without episiotomy, 147 (44.8%) with episiotomy, and 59 (18.0%) with forceps delivery and episiotomy. Hemoglobin values between admission for delivery and discharge ranged from -5.9 g/dl to 0.7 g/dl. Hemoglobin reduction was significantly higher in women having forceps delivery than in those with spontaneous deliveries, with and without episiotomy (p=0.0133 and p<0.0001, respectively). Hemorrhage was greater in the forceps delivery group than in the other groups. Conclusion: The analysis of hemorrhage at vaginal delivery by using hemoglobin and hematocrit indices showed variation among the three types of vaginal delivery studied. There was greater hemorrhage with forceps delivery and less hemorrhage with spontaneous delivery. In women with forceps delivery, postpartum indices were lower than those at hospital admission. ResumoObjetivo: Analisar a hemorragia no parto vaginal através dos índices de eritrócitos e hematócrito. Métodos: Estudo transversal realizado em 328 partos vaginais divididos em: espontâneo, com e sem episiotomia, e parto fórceps. A amostragem foi aleatória estratificada por tipo de parto vaginal. Os dados foram coletados na internação para o parto, na alta hospitalar e no retorno puerperal. Resultados: Foram estudados 122 (37,2%) partos sem episiotomia, 147 (44,8%) com episiotomia e 59 (18,0%) com uso de fórceps e episiotomia. O valor individual de hemoglobina, entre a internação para o parto e a alta hospitalar variou de -5,9 g/dl a 0,7 g/dl.A redução da hemoglobina foi significativamente maior no parto fórceps comparado aos partos espontâneos, com e sem episiotomia, p=0,0133 e p<0,0001, respectivamente. No parto fórceps a hemorragia é maior quando comparada aos outros tipos de parto Conclusão: A análise da hemorragia no parto vaginal através dos índices de eritrócitos e hematócrito evidenciou que há variação nos três tipos de parto vaginal estudados, sendo a hemorragia maior no parto fórceps e menor no parto vaginal espontâneo. No puerpério, nos casos de partos fórceps estes índices mantiveram-se inferiores aos da internação.

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Section: Discussionmentioning

confidence: 99%

Análise da hemorragia no parto vaginal pelos índices de eritrócitos e hematócrito

et al. 2014

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“…Este resultado coincide con otros estudios consultados (29,30) , incluso con los que valoran el test de Ápgar como medida para determinar el bienestar fetal (7,(10)(11)(12)30,31) . Por tanto, la justificación del uso de la episiotomía para la reducción de la morbilidad fetal y neonatal no tendría sustento.…”

Section: Nº 35 Julio 2014unclassified

Factores que influyen en la realización de una episiotomía selectiva en mujeres nulíparas.

Pérez

López²,

Ramos³

et al. 2014

eglobal

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Nº 35 Julio 2014Página 398 ENFERMERÍA Y PERSPECTIVA DE GÉNERO Factores que influyen en la realización de una episiotomía selectiva en mujeres nulíparasFactors affecting the performance of a selective episiotomy in nulliparous women *Hernández Pérez, Javier **Azón López, Esther ***Mir Ramos, Eduardo ****Peinado Berzosa, Ruth *****Val Lechuz, Belén ******Mérida Donoso, RESUMENObjetivo: Determinar los factores que influyen en la realización de una episiotomía selectiva en mujeres nulíparas. Material y método:Se realizó un estudio descriptivo transversal en el Hospital Universitario Miguel Servet (HUMS) de Zaragoza con una muestra de 568 mujeres nulíparas. Se comparó la existencia o no de episiotomía tras el parto con las variables: edad materna, nacionalidad, edad gestacional, peso fetal, hora de nacimiento, sexo fetal, analgesia empleada y profesional que asiste el parto, así como la existencia de desgarros y los resultados del pH de la arteria umbilical fetal.Resultados: La tasa de episiotomía en las mujeres nulíparas en el HUMS de Zaragoza es de un 62%. Entre los factores que influyen en la realización de una episiotomía se encuentran el mayor peso del feto (p =0,000), así como el criterio individual del profesional que asiste el parto. Otros factores como la edad gestacional, el sexo fetal, la analgesia epidural, la hora de nacimiento o la nacionalidad no influyen en su realización. El no hacer episiotomía incrementa los desgarros perineales de primer grado, y en menor medida los de segundo, sin que ocasione un mayor riesgo para el bienestar fetal.

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“…In fact, an episiotomy is associated with more pain, sexual problems, and incontinence after birth (Goer et al, 2007;Hartman et al, 2005;Klein et al, 1994;Renfrew, Hannah, Albers, & Floyd, 1998). Also, episiotomies done to ''prevent'' tears that the provider thinks are about to happen actually cause more tears (Dannecker et al, 2004). The episiotomy rate can be safely lowered to 10% or even lower (Goer et al, 2007).…”

Section: Episiotomymentioning

confidence: 99%

Care Practice #4: No Routine Interventions

Lothian

Amis²

2007

jpe

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This updated edition of Care Practice Paper #4 presents the evidence for risks of routinely intervening in normal physiologic labor and birth. The authors review evidence related to the routine use of restrictions on oral intake, intravenous lines, continuous electronic fetal monitoring, artificial rupture of membranes, pharmacologic augmentation of labor, epidural analgesia, and episiotomy. Medical indications for each intervention are listed. Women are encouraged to avoid routine interventions in labor unless interventions are medically indicated.

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Episiotomy and perineal tears presumed to be imminent: randomized controlled trial

Abstract: Avoiding episiotomy at tears presumed to be imminent increases the rate of intact perinea and the rate of only minor perineal trauma, reduces postpartum perineal pain and does not have any adverse effects on maternal or fetal morbidity.

Cited by 56 publications

References 17 publications

Análise da hemorragia no parto vaginal pelos índices de eritrócitos e hematócrito

Análise da hemorragia no parto vaginal pelos índices de eritrócitos e hematócrito

Factores que influyen en la realización de una episiotomía selectiva en mujeres nulíparas.

Care Practice #4: No Routine Interventions

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