Outcomes of Routine Episiotomy

Hartmann, Katherine E.; Viswanathan, Meera; Palmieri, Rachel T.; Gartlehner, Gerald; Thorp, John M.; Lohr, Kathleen N

doi:10.1001/jama.293.17.2141

Cited by 388 publications

(267 citation statements)

References 39 publications

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“…There is a correlation between the percentage of first and second degree perineal tears (non-severe perineal trauma) and the rate of episiotomies, as this type of perineal tear is higher when no type of episiotomy is performed (2). In fact, with the adoption of a restrictive episiotomy practice the interest in studying risk factors and preventing spontaneous perineal trauma has increased.…”

Section: Discussionmentioning

confidence: 99%

“…Paradoxically, reviews indicate the opposite: episiotomy may actually contribute to severe perineal trauma rather than protect against it (1-4). Although current practice favours a reduction in episiotomies, perineal trauma rates remain high because of the increase in first and second degree tears (2,5,6). Prevalence rates of third and fourth degree perineal lacerations ranges widely from 0.3% to 6% or approximately 1.7% of all births (2.9% in primiparous).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

Irene¹,

Sanchez²,

Francisco³

et al. 2015

IJWHR

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IntroductionHistorically, the use of episiotomy was common for primiparous women in order to prevent severe perineal trauma. Paradoxically, reviews indicate the opposite: episiotomy may actually contribute to severe perineal trauma rather than protect against it (1-4). Although current practice favours a reduction in episiotomies, perineal trauma rates remain high because of the increase in first and second degree tears (2,5,6). Prevalence rates of third and fourth degree perineal lacerations ranges widely from 0.3% to 6% or approximately 1.7% of all births (2.9% in primiparous). Most studies focus on the incidence and the risk factors of more severe perineal trauma including the anal sphincter (7-10). However, few studies have evaluated the incidence of perineal tears that do not affect the anal sphincter. Perineal tears are common following spontaneous vaginal deliveries and practically inevitable in forceps-assisted births (11). Even in mild tears, second degree perineal trauma deserves special consideration as it affects the muscular structure. The muscular damage classified as a second degree tear is equal to or worse than that which results from a routine episiotomy, if it affects the levator ani muscle. A published study on the correlation between episiotomy or perineal tears and pelvic disorders in women who had delivered vaginally 5 to 10 years earlier, concluded that perineal tear was a risk factor for pelvic floor dysfunction but that episiotomy was not (12). Only a small percentage of primiparous women will have an intact perineum after vaginal delivery. There is no data that analyzes the association between episiotomy and mild perineal trauma in primiparous women with spontaneous vaginal delivery. Knowing whether or not an association exists and being able to analyze the risk factors associated with mild perineal tears, would help us reach a better understanding of the appropriate use of episiotomy. The study aimed to estimate the incidence of different types of perineal tears [as classified by the Royal College of Obstetricians (13)] in a group of primiparous women with spontaneous vaginal delivery and to identify factors that could be associated with the presence of second degree perineal trauma. Materials and MethodsThis study is a subset analysis of women who had spontaneous vaginal deliveries from an institutional review Abstract Objectives: To estimate the incidence of perineal trauma in primiparous women with spontaneous vaginal delivery and to identify the factors associated with second-degree lacerations. Materials and Methods: A subset analysis of women with spontaneous vaginal deliveries (n=489) from an institutional review board-approved parent study in healthy, nulliparous, continent pregnant women, attending the public health care system of Catalonia (northeast Spain). Primary outcome measure was perineal trauma according to the RCOG classification. For the bivariate analysis, the Student's t-test, ANOVA and the chi-squared test, or the corresponding non-parametric tests were used. Rat...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

Irene¹,

Sanchez²,

Francisco³

et al. 2015

IJWHR

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“…It is more prevalent in America and Canada than in Europe, because European mothers chose side position during childbirth that provides the gradual stretching of perinea and also the lower incidence of episiotomy [6]. Definitely, available evidence illustrates that routine episiotomy is harmful rather than to be an effective healthcare technique [7][8][9][10]. Due to limited use of episiotomy, 51% -77% of women expressed that they need suture yet for the damages.…”

Section: Introductionmentioning

confidence: 99%

Effect of perineal massage on the incidence of episiotomy and perineal laceration

Zare¹,

Pasha²,

Faramarzi³

2014

Health

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Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are necessary. The aim of study was to determine the effect of perineal massage with a sterile lubricant on the incidence of episiotomy and perinea laceration. Materials: This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating in interventional group (massage with lubricant) (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretched the perineum with lubricant 5 up to 10 minutes, in and between mother's pushing in the second stage of labour. In control group just Ritgen Maneuver was applied. At last, we compared the rate of intact perineum, episiotomy and laceration, mean duration of the second stage of labor and Apgar score in 1 and 5 minutes between two groups. Statistical analyses were performed using t-test, Chi Square to determine potentially significant associations, and a p value less than 0.05 was considered significant. Results: The incidences of intact perineum, episiotomy and laceration were 22.2% (10)

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“…K. Hartmann, M. Viswanathan ir kt. nustatė, jog epiziotomija nėra naudinga sveikatai, tarp rutiniškai taikomos ir indikuotos epiziotomijos esminių skirtumų šiuo aspektu taip pat nėra [12]. Vis dėlto dauguma Vakarų šalių autorių rekomenduoja atsisakyti rutiniškos epiziotomijos ir atlikti ją esant rimtoms indikacijoms [8], ypač esant nestabiliai vaisiaus būklei.…”

Section: Tyrimo Medžiaga Ir Metodaiunclassified

Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų akušerijos ir ginekologijos skyriuje 2015 m. atliktų epiziotomijų pagrįstumas

Obelenytė¹,

Abraitis²

2016

Sveikatos Mokslai

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Raktažodžiai: epiziotomija, naujagimio hipoksija, tarpvietės plyšimas. SantraukaŠio darbo tikslas nustatyti epiziotomijų atlikimo pagrįstumą LSMUL KK Akušerijos ir ginekologijos skyriuje 2015 metais. Atlikta retrospektyvinė gimdyvių, kurioms buvo atlikta mediolateralinė epiziotomija bei naujagimių duomenų analizė. Statistinė duomenų analizė atlikta panaudojant "SPSS 24.0" versijos statistinį paketą. Darbe gauti rezultatai: dieninio/vakarinio intervalo metu priimta 52,23 proc. gimdymų, naktinio/rytinio intervalo metu -47,77 proc. Daugausia gimdymų priimta 17 ir 22 valandomis -po 6,2 proc., mažiausiai -8 valandą 2,2proc. (p>0,05). Daugiausia epiziotomijų -12,4 proc. atliko gydytojas nr. 6 ir akušerė nr. 13 -6,6proc. (p<0,05). Dešimta-daliui naujagimių buvo nustatyta hipoksija ir acidozė kraujyje gimimo metu. 13,75 proc. (n=103) stebejimo atvejų epiziotomija atlikta numatant, kad gims stambus vaisius (≥4000g), 2,7 proc. (n=20)-remiantis numanoma užpakaline vaisiaus pakaušio pozicija. Epiziotomija atlikta po epidurinės nejautros -39 proc. (n=289), kai gimdymas buvo užbaigtas vakuumo ekstraktoriumi -2,7 proc. (n=20) (p<0,05). Atlikus duomenų analizę, paaiškėjo, jog III-IV laipsnio tarpvietės plyšimas įvyko tik 4 stebėjimo atvejams, t.y. 0,5 proc. visos tyrimo imties. Gautos išvados.Tik dešimtadaliui stebejimo atvejų epiziotomija buvo atlikta esant nestabilios vaisiaus būklės indikacijai. Epiziotomijų dažnis priklauso tiek nuo paros laiko, tiek nuo žmogiškojo faktoriaus. 99,5 proc. gimdyvių, kurioms buvo atlikta epiziotomija, gimdymo metu nepatyrė III-IV laipsnio tarpvietės plyšimo, todėl, remiantis literatūros šaltiniais, galima teigti, kad LSMUL KK Akušerijos ir ginekologijos skyriuje tarpvietės apsauga yra geresnė nei kitose Europos šalyse. ĮvadasGimdyvės pasitikėjimas gydytoju yra vienas iš svarbiausių faktorių, užtikrinančių sėkmingą gimdymo eigą. Vienas labiausiai bauginančių besilaukiančias moteris faktorių yra neatitinkantis jų lūkesčių gimdymo stacionare dirbančių gydytojų ir akušerių elgesys, paskatinantis moteris ieškoti alternatyvos. Kaip teigia D. Brogienė, kiekvienas praktikuojantis gydytojas akušeris-ginekologas pritartų, jog moteriai saugiausia gimdyti gimdymo stacionare, tačiau jos teigia, jog jaučiasi saugiau gimdydamos namuose, nes tikisi mažiau intervencijų, tokių kaip skatinimo, epiziotomijų, instrumentinių gimdymo užbaigimų [1]. Įprastai šio-se diskusijose moterys akcentuoja ne fizinį, bet emocinį ir psichologinį saugumą. 2006 m. Ženevoje 19 tarptautinių organizacijų paskelbė tarptautinę "Motinai ir naujagimiui palankaus gimdymo" iniciatyvą [2]. Šioje iniciatyvoje suformuluota 10 žingsnių,remiantis "Motinai palankaus gimdymo iniciatyvos" koalicijos CIMS (The Coalition for Improving Maternity services) ekspertų darbo grupės atlikta sistemine mokslinių tyrimų (nuo 1990 iki 2006 m.) apžvalga. Viename iš šių žingsnių teigiama, jog "Motinai palanki ligoninė"sumažina tokias intervencijas, kaip gimdymo stimuliacija 10 proc. ar mažiau, bei epiziotomijų 20 proc. ar mažiau, siekiant jas sumažinti iki 5 pro...

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Outcomes of Routine Episiotomy

Cited by 388 publications

References 39 publications

Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

Effect of perineal massage on the incidence of episiotomy and perineal laceration

Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų akušerijos ir ginekologijos skyriuje 2015 m. atliktų epiziotomijų pagrįstumas

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