Perineal prevention and protection in obstetrics: CNGOF clinical practice guidelines

Abstract

Introduction: The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter injuries (OASIS) and postnatal pelvic floor symptoms.Material and methods: These guidelines were developed in accordance with the methods prescribed by the French Health Authority (HAS).Results: A prenatal clinical examination of the perineum is recommended for women with a history of Crohn's disease, OASIS, genital mutilation, or perianal lesions (professional consensus). Just after delivery, a perineal examination is recommended to check for OASIS (Grade B); if there is doubt about the diagnosis, a second opinion should be requested (Grade C). In case of OASIS, the injuries (including their severity) and the technique for their repair should be described in detail (Grade C). Perineal massage during pregnancy must be encouraged among women who want it (Grade B). No intervention conducted before the start of the active phase of the second stage of labour has been shown to be effective in reducing the risk of perineal injury. The crowning of the baby's head should be manually controlled and the posterior perineum manually supported to reduce the risk of OASIS (Grade C). The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). In instrumental deliveries, episiotomy may be indicated to avoid OASIS (Grade C). When an episiotomy is performed, a mediolateral incision is recommended (Grade B). The indication for episiotomy should be explained to the woman, and she should consent before its performance. Advising women to have a caesarean delivery for primary prevention of postnatal urinary or anal incontinence is not recommended (Grade B). During pregnancy and again in the labour room, obstetrics professionals should focus on the woman's expectations and inform her about the modes of delivery.

Stress urinary incontinence after labor and satisfaction with sex life

“…This may suggest that perineum damage during labor, irrespective of its underlying cause, increases the risk of incontinence occurrence. This assumption is further confirmed by the fact that routine episiotomy during labor, as incontinence prophylaxis, is controversial amongst vari-ous authors [10,[19][20][21][22]. Presumptions about the protective effect of surgical labor on urinary incontinence on the basis of the accumulated data have to be attempted very carefully as it is not clear whether urinary incontinence occurred during pregnancy, which ended in Caesarean section due to various causes.…”

In vivo assessment of the elastic properties of women’s pelvic floor during pregnancy using shear wave elastography: design and protocol of the ELASTOPELV study

“…-Data related to mode of delivery After childbirth, we will obtain the following data from the subjects' medical files: [35,36].…”

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

“…The midwife or the obstetrician can perform an episiotomy to facilitate the childbirth in case of severe fetal heart rate anomaly, and it is occasionally conducted to prevent obstetric anal sphincter injury in vaginal delivery [2]. Considering all maternal consequences of episiotomy, its routine use has been questioned, and restrictive episiotomy policies are recommended by clinical practice guidelines [3,4].…”