Variations in rates of severe perineal tears and episiotomies in 20 European countries: a study based on routine national data in Euro‐Peristat Project

Blondel, Béatrice; Alexander, Sophie; Bjarnadóttir, Ragnheiður I.; Gissler, Mika; Langhoff‐Roos, Jens; Novak-Antolič, Živa; Prunet, C.; Zhang, Wei Hong; Hindori-Mohangoo, Ashna D.; Zeitlin, Jennifer

doi:10.1111/aogs.12894

Cited by 162 publications

(138 citation statements)

References 24 publications

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“…Over the same period, severe perineal tears (third and fourth degrees) significantly increased in women who had non-operative vaginal deliveries. These results were consistent with those of the Euro-peristat project, which described an increase in the rate of severe perineal tears for all vaginal deliveries between 2004 and 2010 in all European countries, except Germany and Norway [28]. This issue is still the subject of a controversial debate [7, 9, 20, 29–32].…”

Section: Discussionsupporting

confidence: 89%

How did episiotomy rates change from 2007 to 2014? Population-based study in France

Goueslard

Cottenet

Roussot

et al. 2018

BMC Pregnancy Childbirth

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BackgroundSince the 2000s, selective episiotomy has been systematically recommended worldwide. In France, the recommended episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with episiotomy.MethodsThis population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with episiotomy for non-operative vaginal deliveries and the risk factors related to the women’s characteristics and the birth environment.ResultsThere were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23–1.30]), epidural analgesia (aOR = 1.45 [1.43–1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47–1.49]), and giving birth for the first time (aOR = 3.85 [3.84–4.00]).ConclusionsThe episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1747-8) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 89%

How did episiotomy rates change from 2007 to 2014? Population-based study in France

Goueslard

Cottenet

Roussot

et al. 2018

BMC Pregnancy Childbirth

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“…According to a recent study comparing rates of episiotomy in 20 European countries found important differences, varying from 3,7% in Denmark to 75% in Cyprus [32]. In other institutes and in other countries in which episiotomy is practiced selectively, the present results are expected to encourage further studies to find answers to the more decisive questions: Is it time to stop performing episiotomies?…”

Section: Discussionmentioning

confidence: 52%

Selective episiotomy vs. implementation of a non-episiotomy protocol: a randomized clinical trial

et al. 2017

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BackgroundDespite all the evidence corroborating the selective use of episiotomy and although routine use of the procedure is contraindicated, there are no evidences corroborating if episiotomy is necessary in any circumstance. The present clinical randomized trial was performed to compare maternal and perinatal outcomes in women submitted to a non-episiotomy protocol versus one of selective episiotomy.MethodsAn open-labelled, randomized clinical trial was carried out in a tertiary teaching hospital in Recife, Northeastern Brazil. Women in labor with a full-term live foetus, dilatation of 6 to 8 cm and cephalic presentation (vertex position) were included. Exclusion criteria consisted of bleeding disorders and an indication for a caesarean section. After signing the consent form, 241 women were randomized to a non-episiotomy protocol (the experimental group) or to a selective episiotomy group (the control group). No episiotomies were to be performed in the experimental group except under exceptional circumstances. In the control group, selective episiotomies were to be performed in accordance with the healthcare professionals’ clinical judgement. Maternal and perinatal outcomes were evaluated. Ratio Risk (RR) and the 95% confidence interval (95% CI) were calculated for our outcomes.ResultsThe analysis include 115 women assigned to a non-episiotomy protocol and 122 to selective episiotomy. There was no difference between the two groups with respect to maternal or perinatal outcomes. The episiotomy rate was similar (two cases in each group, about 1.7%), as was the duration of the second stage of labor, the frequency of perineal tears, severe perineal trauma, need for perineal suturing and blood loss at delivery.ConclusionsA non-episiotomy protocol appears to be safe for mother and child, and highlights the need to investigate whether there is, in fact, any indication for this procedure.Trial registrationThis trial was registered at ClinicalTrials.gov under reference number (NCT02178111).

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“…Remiantis A. Kudrevičienės ir kt. [16] analizės duomenimis, kai virkštelės kraujo pH <7,2 -tai traktuojama kaip acidozė, patvirtinanti, jog yra naujagimio hipoksija.…”

Section: Tyrimo Medžiaga Ir Metodaiunclassified

“…Remiantis Blondel B. ir kt. [16] duomenimis, III -IV laipsnio tarpvietės plyšimo dažnis Europos šalyse (Danijoje 4,8 proc., Estijoje 0,9 proc., Suomijoje 1,1 proc., Vokietijoje 1,8 proc., Islandijoje 4,9 proc., Švedijoje 3,5 proc., Olandijoje 2,7 proc., Jungtinėje Karalystėje 3,2 proc.) didesnis nei LSMUL KK Akušerijos ir ginekologijos skyriuje.…”

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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Variations in rates of severe perineal tears and episiotomies in 20 European countries: a study based on routine national data in Euro‐Peristat Project

Abstract: The large variations in severe tears and episiotomies and the negative association between these indicators in 2010 show the importance of improving the assessment and reporting of tears in each country, and evaluating the impact of low episiotomy rates on the perineum.

Cited by 162 publications

References 24 publications

How did episiotomy rates change from 2007 to 2014? Population-based study in France

How did episiotomy rates change from 2007 to 2014? Population-based study in France

Selective episiotomy vs. implementation of a non-episiotomy protocol: a randomized clinical trial

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

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