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

Pérez, Javier Hernández; López, Esther Azón; Ramos, Eduardo Mir; Berzosa, Ruth Peinado; Lechuz, Belén Val; Donoso, Ángel Mérida

doi:10.6018/eglobal.13.3.196531

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…The main strength of our study was that caregivers/health professionals were provided with training on the different types of tears to be able to classify them correctly. This aspect was overlooked in other studies (18,39). A limitation of this study was that other variables reported in other studies such as maternal age, maternal weight, maternal height (40), maternal pathology, perineal protection (15), newborn biparietal diameter (14) duration of first stage of labour, duration of second stage of labour (40) and clinicians’ attitudes were not studied (14,40).…”

Section: Discussionmentioning

confidence: 82%

“…There is conflicting evidence regarding the relationship on the use of epidural analgesia and the performance of an episiotomy. While some studies demonstrate an association (15,19), other studies do not demonstrate a statistically significant relationship (18). The association of epidural analgesia and severe perineal damage have also been reported (15,24) but this is also controversial, with another study not showing any relationship between these factors (25).…”

Section: Discussionmentioning

confidence: 97%

“…In several studies the birth weight was found to be associated with severe perineal trauma (25,36-38). Birth weight is an important factor which influences the rates of episiotomies (18,33). Despite this, other studies revealed no effect of birth weight on perineal damage (14) and that birth weight was not associated with the performance of episiotomies (14,39).…”

Section: Discussionmentioning

confidence: 99%

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Intact Perineum: What are the Predictive Factors in Spontaneous Vaginal Birth?

et al. 2019

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Introduction: Perineal trauma at birth is distressing for women and can cause serious short and long term morbidity. Aim: Investigate the prevalence and predictive factors of intact perineum after normal vaginal birth among Portuguese women who had spontaneous vaginal births. Methods: A descriptive, cross-sectional, retrospective study was carried out among pregnant women who had spontaneous vaginal births, between January 1, 2017, and December 31, 2017, in a single birth centre in Portugal. Following ethical approval, the prevalence of intact perineum was calculated and multivariate analysis with logistic regression was carried out, to identify the predictive factors of having an intact perineum after spontaneous vaginal birth. Results: A total of 1748 pregnant women had spontaneous vaginal births. Four hundred and forty-one women (25.2%) had intact perineum whereas in 1307 (74.8%) of women, the perineum was not intact. First-degree tears occurred in 23.2% (405/1748) of women, second-degree tears occurred in 4% (70/1748) of women while three women (0.2%) experienced a third-degree tear. The rate of episiotomies was 43.8% (766/1748). Episiotomy and first-degree tears occurred in 2.6% (45/1748), episiotomy and second-degree tears occurred in 0.7% (12/1748), while episiotomy and third-degree tears occurred in 0.3% (6/1748) of women. Having a previous caesarean section reduced the odds of intact perineum by 60%, while nulliparity reduced the odds by 70%. For every 250 grams increase in birth weight, the odds of sustaining an intact perineum were decreased by 13%. Alternative birth positions (excluding lithotomy) doubled the odds of maintaining an intact perineum. Conclusion: The prevalence of intact perineum is 25,2%. Predictive factors for intact perineum include birth weight, parity, previous caesarean section and birthing position. Recognizing these factors could support and facilitate the management of spontaneous vaginal birth to promote an intact perineum. Further research is needed to gain better understanding of this phenomenon.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Intact Perineum: What are the Predictive Factors in Spontaneous Vaginal Birth?

et al. 2019

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“…In a study carried out with 568 nulliparas in a tertiary hospital in Zaragoza, Spain, in the group that did not have an episiotomy, there was a significant increase of first-degree tears compared to second-degree tears (55.6% and 15.7%, respectively), without causing any risk to fetal well-being (22) . The results were similar in the present study, in terms of slight perineal tears which, if necessary, may be sutured by an obstetric nurse, with a perineal outcome without clinical complications.…”

Section: Discussionmentioning

confidence: 97%

Factors related to perineal outcome after vaginal delivery in primiparas: a cross-sectional study

Souza

Farias

Ribeiro

et al. 2020

Rev. esc. enferm. USP

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Objective: Identify the associations between perineal outcome in primiparas and interventions during labor and delivery, newborn weight and APGAR score. Method: Document-based, correlational, retrospective, quantitative study conducted in a tertiary maternity hospital in the state of Ceará, between July 2017 and January 2018. The independent variables were labor induction, amniotomy, non-pharmaceutical methods for relieving pain, forceps, episiotomy, Kristeller maneuver, position in the expulsion stage, shoulder dystocia, and newborn weight and APGAR score, and the dependent variable was perineal outcome. Pearson's chi-square test and Fisher's exact test were used. Results: A total of 226 normal-risk primiparas who had a vaginal delivery. An association was found between horizontal position in the expulsion stage and episiotomy, and between not performing an episiotomy and perineal tearing. The other variables (labor, delivery and neonatal) did not have any effect on perineal tearing. Conclusion: Interventions, with the exception of episiotomies, did not have an influence on the occurrence of perineal trauma, but they do need to be carefully assessed. Deliveries in a horizontal position were associated with a higher likelihood of performing an episiotomy.

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“…The male gender was found to be another independent risk factor of an episiotomy in our study. However, in a Spanish study by Hernandez et al (2014) [ 34 ] and the study from Ethiopia by Marai (2002) [ 35 ], no difference between the sex of the child and the episiotomy procedure was shown.…”

Section: Discussionmentioning

confidence: 99%

Episiotomy for Medical Indications during Vaginal Birth—Retrospective Analysis of Risk Factors Determining the Performance of This Procedure

Bączek

Rychlewicz²,

Sys

et al. 2022

JCM

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The WHO (World Health Organization) recommends that the percentage of perineal incisions should not exceed 10%, indicating that this is a good goal to achieve, despite the fact that it is still a frequently used medical intervention in Poland. The risk factors for perineal incision that have been analyzed so far in the literature allow, among others, to limit the frequency of performing this procedure. Are they still valid? Have there been new risk factors that we should take into account? We have conducted this study to find the risk factors for performing perineal incision that would reduce the frequency of this procedure. The aim of the study was to check whether the risk factors that were analyzed in the literature are still valid, to find new risk factors for perineal incisions and to compare them among Polish women. This was a single-center retrospective case-control study. The electronic patient records of Saint Sophia’s Hospital in Warsaw, Poland, a tertiary hospital was used to create an anonymous retrospective database of all deliveries from 2015 to 2020. The study included the analysis of two groups, the study group of patients who had had an episiotomy, and the control group-patients without an episiotomy in cases where an episiotomy was indicated. A logistic regression model was developed to assess the risk factors for perineal laceration. Independent risk factors for episiotomy in labor include oxytocin use in the second stage of labor (OR (Odds Ratio) = 6.00; 95% CI (Confidence Interval): 4.76–7.58), the supply of oxytocin in the first and the second stage of labor (OR = 3.18; 95% CI: 2.90–3.49), oxytocin use in the first stage of labor (OR = 2.72; 95% CI: 2.52–3.51), state after cesarean section (OR = 2.97; 95% CI: 2.52–3.51), epidural anesthesia use (OR = 1.77; 95% CI: 1.62–1.93), male gender (OR = 1.10; 95% CI: 1.02–1.19), and prolonged second stage of labor (OR = 1.01; 95% CI: 1.01–1.01). A protective factor against the use of an episiotomy was delivery in the Birth Centre (OR = 0.43; 95% CI: 0.37–0.51) and mulitpara (OR = 0.31; 95% CI: 0.27–0.35). To reduce the frequency of an episiotomy, it is necessary consider the risk factors of performing this procedure in everyday practice, e.g., limiting the use of oxytocin or promoting alternative places of delivery.

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

Cited by 5 publications

References 17 publications

Intact Perineum: What are the Predictive Factors in Spontaneous Vaginal Birth?

Intact Perineum: What are the Predictive Factors in Spontaneous Vaginal Birth?

Factors related to perineal outcome after vaginal delivery in primiparas: a cross-sectional study

Episiotomy for Medical Indications during Vaginal Birth—Retrospective Analysis of Risk Factors Determining the Performance of This Procedure

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