Recommendations for the management of low risk obstetric patients

Abstract

Specific interventional procedures have enjoyed widespread popularity in the United States in the routine management of low risk obstetric patients without the benefit of clinical studies attesting to their utility. A review of the literature was conducted to survey obstetric practice with regard to amniotomy, intravenous fluids, third stage administration of oxytocics, episiotomy and continuous fetal monitoring.

Effects of episiotomy on bonding and mothers’ health

“…Women giving birth by normal vaginal delivery may have either episiotomy or spontaneous laceration or both. Episiotomy is carried out in these women to decrease the rate of spontaneous laceration (Thorp & Bowes 1989, Davis & Riedmann 1991, Fernando et al. 1995).…”

“…It has been reported in the literature that episiotomy prevents weakness of perineal muscle and thus development of stress incontinence (Davis & Riedmann 1991, Bobak & Jensen 1993). In our study, it was found that mothers in the episiotomy group had a lower rate of urinary incontinence than those in the control group, although the difference was not statistically significant.…”

“…1999). It has been suggested in recent studies that episiotomy should be carried out when presentation position is abnormal, vacuum or forceps are used, the foetus is big and/or the perineum is rigid (Davis & Riedmann 1991, Mcilhargie 1995, Taşkın 2000).…”

Factors related to perineal trauma in childbirth

“…It is the most common operation in obstetrics, with 50% of vaginal births in the United States still accompanied by episiotomy (2). Several meta analyses in the past decade have assessed the legitimate place of routine episiotomy in obstetric practice (3–5). Although episiotomy may be indicated to shorten the second stage of labor for reasons of maternal or fetal distress, no data support any short‐ or long‐term health benefits of routine episiotomy.…”

Intervenções Obstétricas No Trabalho De Parto Em Mulheres Submetidas À Cesariana

“…As pesquisas mostram que a adoção de procedimentos desnecessários ou inadequadamente utilizados, como amniotomia precoce, infusão endovenosa de ocitocina e analgesia, alteram o curso fisiológico do parto e desencadeiam uma cascata de eventos, em que uma intervenção condiciona a outra. Com isso, elevamse progressivamente o nível de complexidade dos procedimentos e o risco obstétrico e perinatal (1,5) .…”