Does Episiotomy Prevent Perineal Trauma and Pelvic Floor Relaxation?

Kleín, Michael C.; Gauthier, Robert; Jorgensen, S H; Robbins, James M.; Kaczorowski, Janusz; Johnson, B; Corriveau, Marc M.; Westreich, Ruta; Waghorn, Kathy; Gelfand, Morrie M.

doi:10.1097/00006254-199404000-00008

Cited by 51 publications

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“…The overall results of this study coincide with other studies [16][17][18] that demonstrate a higher proportion of 1 st and 2 nd degree tears in births without an episiotomy, while it also confirms that the proportion of severe perineal tears remain lower than 1% of births in which an episiotomy was performed as well as in those without an episiotomy. The proportion of severe perineal tears found in Catalonia is lower than that found in the majority of studies conducted [19][20][21] probably because, in this study, instrumental deliveries were excluded, as they usually exhibit a higher incidence of perineal tears.…”

Section: Discussionsupporting

confidence: 91%

Vaginal Delivery Care, Episiotomy Performance and Examination of Severe Perineal Tears: Cross-Sectional Study in 43 Public Hospitals

Escuriet¹,

Pueyo²,

García-Lausín³

et al. 2017

OGIJ

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Submit Manuscript | http://medcraveonline.com This approach became the project for normal birth assistance, gradually introduced into healthcare practice across the region of Catalonia. This work developed via three specific courses of action aimed at improving the infrastructure in maternity wards in hospitals, raising professionals' awareness and promoting women's participation in maternity care. All of these actions are coordinated by the Catalan Ministry of Health in order to involve all stakeholders and achieve greater consensus in promoting a model of normal childbirth care that is based on known recorded services the profile of the professional best practice.In 2013, a maternity care assessment was performed to explore obstetric interventions conducted on singleton, full-term deliveries in all hospitals in 2014 in Catalonia [2]. In our environment care provided at birth in women with normal pregnancy is assumed mostly by midwives, but the exact proportion of births attended by midwives is not known. The assessment revealed, among other things, a downward trend in the performance of episiotomies in public hospitals and, further, no significant increase in the incidence of severe perineal tears [3]. Based on this evaluation, new lines of research were undertaken to respond to aspects of maternal and child health requiring improvement but for which the information needed for planning effective services currently does not exist. It has been shown that midwife-led care during low/medium risk pregnancy, labour, delivery and postpartum is associated with benefits for mothers and newborns, with no Research ArticleObstet Gynecol Int J 2017, 7(6): 00270 AbstractIntroduction: In recent years work has been done in the public health system in Catalonia in order to achieve consensus in promoting a model of normal childbirth care. This study aims to ascertain the proportion of singleton, full-term vaginal non-instrumental births attended in public hospitals for which an episiotomy was performed and the incidence of severe perineal tears. Methodology:Descriptive cross-sectional study of all singleton births between 37 and 41 completed weeks of gestation attended in public hospitals (2013)(2014). Births were grouped into two groups "deliveries with episiotomy" and "deliveries without episiotomy". Hospitals were grouped by level of complexity (I to III -according to the Catalonia health department classification). The relationship between qualitative variables was analysed using a chi-square test and the T-student test was used for quantitative variables; a p value equal to or lower than 0.005 was considered significant. Results: Data were collected from 53770 births. The total percentage of perineal tears was 35.7% and the total of severe tears was 0.8%. No significant differences in the mean proportion of severe perineal tears among different types of hospitals or between the two groups. The regression analysis shows that the birth weight of the newborn is the only variable that increases the risk of experiencing a seve...

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Section: Discussionsupporting

confidence: 91%

Vaginal Delivery Care, Episiotomy Performance and Examination of Severe Perineal Tears: Cross-Sectional Study in 43 Public Hospitals

Escuriet¹,

Pueyo²,

García-Lausín³

et al. 2017

OGIJ

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“…Klein et al found no diff erence in perineal trauma and pain after vaginal delivery with the use of restrictive midline episiotomy in primiparous women compared to routine approach. Th ere was no diff erence in urinary incontinence and other symptoms of pelvic fl oor damage 3 months following delivery either, suggesting that routine episiotomy has not protective eff ect on the pelvic fl oor 63 . One study dealing with the phenomenon of pelvic relaxation after vaginal delivery showed that episiotomy caused decreased strength of pelvic fl oor muscles 64 .…”

Section: Impact Of Episiotomy On Urinary Incontinence After Deliverymentioning

confidence: 92%

Effect of Delivery and Episiotomy on the Emergence of Urinary Incontinence in Women: Review of Literature

Živković

Župić

et al. 2016

acc

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SUMMARY -Episiotomy is obstetric procedure during which the incision extends the vestibule of the vagina during the second stage of labor. Episiotomy was extensively spread with gradual increase of rates in the fi rst half of the 20 th century and was performed mediolaterally in all nulliparous women with the idea to protect fetal head from trauma and pelvic fl oor from injuries. However, reports claiming that episiotomy had no such benefi ts were published. It was shown that routine mediolateral episiotomy did not protect against the appearance of urinary incontinence after vaginal delivery, while the risk of anal incontinence could be increased. Th e role of episiotomy in development of pelvic fl oor dysfunction remains quite unclear. Due to the mentioned reason, restricted episiotomy approach should be accepted. Th e origin of stress incontinence during pregnancy is controversial and not definitely scientifi cally proven. Pregnancy per se and older age at fi rst delivery may have impact on the onset of pelvic fl oor dysfunction. Urinary incontinence in pregnancy increases the risk of later urinary incontinence, both postpartum and later in life. Vaginal delivery is just one of the potential risk factors for development of urinary incontinence. Mechanical pressure by fetus on the pelvic fl oor structures, limited denervation of the pelvic fl oor and soft tissue damage during delivery are some of explanations for the onset of stress urinary incontinence. On the other hand, cesarean delivery might not be protective against emergence of urinary incontinence. Further research in this fi eld is needed.

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“…Les épisiotomies médio-latérales larges sectionnent le faisceau puborectal du muscle releveur droit et compromettent ainsi un des mécanismes de la continence alors même qu'il est aujourd'hui démontré que ce geste réalisé de manière systématique ne protége pas des déchirures sphinctériennes graves [5][6][7][8]. L'épisiotomie médiane est délétère et sectionne souvent le sphincter anal externe [9].…”

Section: Données De La Littératureunclassified

Contre la césarienne en prévention de l'incontinence anale

Dupuis¹

2007

Gynécologie Obstétrique & Fertilité

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Does Episiotomy Prevent Perineal Trauma and Pelvic Floor Relaxation?

Cited by 51 publications

References 0 publications

Vaginal Delivery Care, Episiotomy Performance and Examination of Severe Perineal Tears: Cross-Sectional Study in 43 Public Hospitals

Vaginal Delivery Care, Episiotomy Performance and Examination of Severe Perineal Tears: Cross-Sectional Study in 43 Public Hospitals

Effect of Delivery and Episiotomy on the Emergence of Urinary Incontinence in Women: Review of Literature

Contre la césarienne en prévention de l'incontinence anale

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