The Use of Episiotomy in a Low‐Risk Population in The Netherlands: A Secondary Analysis

Seijmonsbergen-Schermers, Anna; Geerts, Caroline C.; Prins, Marianne; Diem, Mariet Th. van; Klomp, Trudy; Lagro-Janssen, A.L.M.; Jonge, Ank de

doi:10.1111/birt.12060

Cited by 26 publications

(24 citation statements)

References 57 publications

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“…In this sense, our work is valuable as it presents a cohort of primiparous women with spontaneous vaginal delivery. Furthermore, most studies focusing on primiparous women include a relatively small sample (4,17,18); according to these studies, the rate of episiotomies for primiparous women (including spontaneous and instrumental deliveries) following a selective episiotomy practice ranges between 20.9% (19) and 53%. The overall rate of episiotomy by spontaneous vaginal delivery in current study is 63.4% (95% CI: 59.0%-67.8%).…”

Section: Discussionmentioning

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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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%

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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“…In addition, regional variation in performing an episiotomy was considerably larger than the variation in severe perineal tears. An episiotomy is often performed to prevent severe perineal tears [43,45]. However, literature supports other methods to reduce the rate of third or fourth degree tears which do not have adverse effects [46][47][48].…”

Section: Interpretation and Further Researchmentioning

confidence: 99%

Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider: A nationwide explorative study

Seijmonsbergen-Schermers

Zondag

Nieuwenhuijze

et al. 2020

PLoS ONE

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Background Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. Methods In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks' gestation in 2010-2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife-and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman's rank correlations.

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“…Entretanto, estudos mostram discrepância relevante na incidência de episiotomia entre países. Na Europa do Norte e Ocidental as taxas variam entre 9,7% na Suécia e 87,3% na Espanha (13) . Na França, entre 2004 e 2009, a incidência reduziu de 55,7% para 13,3%, sem aumentar de maneira significativa os traumas perineais.…”

Section: Discussionunclassified

Prática De Episiotomia Entre Residentes Em Enfermagem Obstétrica

et al. 2018

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Objetivo: identificar a frequência e justificativa para a realização da episiotomia em partos assistidos por residentes em enfermagem obstétrica. Método: estudo descritivo e retrospectivo, realizado no período de outubro a novembro de 2016, em uma maternidade pública do município de São Paulo. A população do estudo foi constituída por 884 parturientes de baixo risco. Para análise estatística, utilizou-se o teste Qui-Quadrado. Resultados: a episiotomia ocorreu em 174 (19,7%) partos e em 512 (59%) houve lacerações perineais. A integridade perineal foi mantida em 187 (21,4%) partos. As principais indicações estiveram relacionadas às condições do períneo: 54 (58,1%) por rigidez perineal, 22 (23,7%) períneo curto e 19 (20,4%) eminência de laceração grave. Conclusão: a prática de episiotomia entre residentes está acima do recomendado pela OMS e, com relação às justificativas apresentadas, há discrepância com as mundialmente utilizadas, trazendo reflexões acerca do modelo de formação e do distanciamento entre teoria e prática.

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The Use of Episiotomy in a Low‐Risk Population in The Netherlands: A Secondary Analysis

Abstract: The incidence of episiotomy is high compared with some low-risk settings in other Western countries. Episiotomy was associated with higher rates of adverse maternal outcomes. Restricted use of episiotomy is likely to be beneficial for women.

Cited by 26 publications

References 57 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?

Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider: A nationwide explorative study

Prática De Episiotomia Entre Residentes Em Enfermagem Obstétrica

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