Episiotomy and perineal tears presumed to be imminent: the influence on the urethral pressure profile, analmanometric and other pelvic floor findings – follow‐up study of a randomized controlled trial

Dannecker, Christian; Hillemanns, Peter; Strauß, Alexander; Hasbargen, Uwe; Hepp, H.; Anthuber, C.

doi:10.1111/j.0001-6349.2005.00585.x

Cited by 18 publications

(27 citation statements)

References 31 publications

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“…Seven of the 11 studies were carried out in high-income countries, including Canada (Klein 1992), Germany (Dannecker 2004), Ireland (Harrison 1984), Spain (Juste-Pina 2007), and the UK (House 1986; Murphy 2008b; Sleep 1984). Five of the studies were conducted in middle- and low-income countries, and these included Argentina (Belizan 1993), Columbia (Rodriguez 2008), Malaysia (Sulaiman 2013), Pakistan (Ali 2004), and Saudi Arabia (Eltorkey 1994). …”

Section: Resultsmentioning

confidence: 99%

Selective versus routine use of episiotomy for vaginal birth

Jiang

Qian

Carroli

et al. 2017

Cochrane Database of Systematic Reviews

315

340

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Background Some clinicians believe that routine episiotomy, a surgical cut of the vagina and perineum, will prevent serious tears during childbirth. On the other hand, an episiotomy guarantees perineal trauma and sutures. Objectives To assess the effects on mother and baby of a policy of selective episiotomy ('only if needed') compared with a policy of routine episiotomy ('part of routine management') for vaginal births. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register (14 September 2016) and reference lists of retrieved studies. Selection criteria Randomised controlled trials (RCTs) comparing selective versus routine use of episiotomy, irrespective of parity, setting or surgical type of episiotomy. We included trials where either unassisted or assisted vaginal births were intended. Quasi‐RCTs, trials using a cross‐over design or those published in abstract form only were not eligible for inclusion in this review. Data collection and analysis Two authors independently screened studies, extracted data, and assessed risk of bias. A third author mediated where there was no clear consensus. We observed good practice for data analysis and interpretation where trialists were review authors. We used fixed‐effect models unless heterogeneity precluded this, expressed results as risk ratios (RR) and 95% confidence intervals (CI), and assessed the certainty of the evidence using GRADE. Main results This updated review includes 12 studies (6177 women), 11 in women in labour for whom a vaginal birth was intended, and one in women where an assisted birth was anticipated. Two were trials each with more than 1000 women (Argentina and the UK), and the rest were smaller (from Canada, Germany, Spain, Ireland, Malaysia, Pakistan, Columbia and Saudi Arabia). Eight trials included primiparous women only, and four trials were in both primiparous and multiparous women. For risk of bias, allocation was adequately concealed and reported in nine trials; sequence generation random and adequately reported in three trials; blinding of outcomes adequate and reported in one trial, blinding of participants and personnel reported in one trial. For women where an unassisted vaginal birth was anticipated, a policy of selective episiotomy may result in 30% fewer women experiencing severe perineal/vaginal trauma (RR 0.70, 95% CI 0.52 to 0.94; 5375 women; eight RCTs; low‐certainty evidence). We do not know if there is a difference for blood loss at delivery (an average of 27 mL less with selective episiotomy, 95% CI from 75 mL less to 20 mL more; two trials, 336 women, very low‐certainty evidence). Both selective and routine episiotomy have little or no effect on infants with Apgar score less than seven at five minutes (four trials, no events; 3908 women, moderate‐certain...

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Section: Resultsmentioning

confidence: 99%

Selective versus routine use of episiotomy for vaginal birth

Jiang

Qian

Carroli

et al. 2017

Cochrane Database of Systematic Reviews

315

340

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“…Twenty-one studies investigating augmented MUCP were found (Table 1) [14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. One study was excluded because the results combined values for men and women [37].…”

Section: Experimental Studiesmentioning

confidence: 99%

“…When this criterion was applied to women with either SUI or prolapse, between 39 % and 60 % achieved an effective contraction. Furthermore, a number of studies reported a reduction in MUCP during PFM contraction compared with the resting measurement [14,26,32,36]. All of these studies included women with possible injuries to the pelvic floor.…”

Section: Augmentation Of Mucp By Pelvic Floor Contractionmentioning

confidence: 99%

Influence of voluntary pelvic floor muscle contraction and pelvic floor muscle training on urethral closure pressures: a systematic literature review

et al. 2015

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“…Žádná ze studií však nepotvrdila, že by rutinní provádění epiziotomií vedlo ke snížení močové inkontinence u žen po porodu (35,36,37,38,39).…”

Section: Legenda: Ns (Not Significant) -Nesignifikantní Hodnota; or (unclassified

Perineal trauma and its effect on the pelvic floor and urinary incontinence

Kramná¹,

Vrublová²

2016

Profese on-line

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1Ústav ošetřovatelství a porodní asistence, Lékařská fakulta, Ostravská univerzita, Ostrava, Česká republika 2 Gynekologicko-porodnická klinika, Lékařská fakulta, Ostravská univerzita, Ostrava, Česká republika ABSTRAKT Východiska: Vysoká prevalence močové inkontinence u žen představuje celosvětový problém. Častější výskyt problémů s únikem moči byl zaznamenán u žen po porodu. Některé studie zjistily souvislost mezi močovou inkontinencí a porodním poraněním. Cíl: Zjistit vliv porodního poranění hráze (epiziotomie, spontánní ruptury) na pánevní dno a močovou inkontinenci. Metody: K vyhledávání literárních zdrojů byly využity elektronické databáze Medline, Cinahl, Pub Med, Science Direct, Scopus, Medvik a elektronické vyhledávače Google a Google Scholar. Byly vyhledávány články v českém nebo anglickém jazyce. Při vyhledávání byla zadána klíčová slova: perineal trauma, episiotomy, childbirth, urinary incontinence. Celkem bylo dohledáno 21 studií: 1 metaanalýza, 3 systematická review, 2 randomizované kontrolované studie a 15 kohortových studií. Výsledky: Ženy s intaktní hrází měly silnější pánevní dno než ženy s porodním poraněním, přestože se významně nelišily ve výskytu močové inkontinence. Nebyla prokázána souvislost mezi močovou inkontinencí a rozsahem spontánního poranění. Epiziotomie nechrání pánevní dno a neredukuje výskyt močové inkontinence u žen po porodu. Závěr: Snahou porodníků a porodních asistentek by měla být maximální redukce porodních poranění hráze. V žádné studii nebyl ale prokázán pozitivní vliv epiziotomie na pánevní dno a snížení výskytu močové inkontinence, proto by v praxi měly být epiziotomie prováděny jen v indikovaných případech. ABSTRACTBackground: High prevalence of urinary incontinence in women is a worldwide problem. Higher incidence of problems with urinary incontinence was observed in women after childbirth. Some studies have found a connection between urinary incontinence and perineal trauma. Aim: To determine the influence of perineal trauma (episiotomy, spontaneous rupture) on the pelvic floor and urinary incontinence. Methods: In search for sources we used the electronic databases Medline, CINAHL, PubMed, Science Direct, Scopus, Medvik, and the electronic search engines Google and Google Scholar. We searched for articles in Czech or English. The following keywords were used: perineal trauma, episiotomy, childbirth, urinary incontinence. A total of 21 studies were found: 1 meta-analysis, 3 systematic reviews, 2 randomized controlled trials, and 15 cohort studies. Results: Women with an intact perineum had a stronger pelvic floor than women with a perineal injury, although they did not differ significantly in the incidence of urinary incontinence. A relationship between urinary incontinence and the extent of a spontaneous injury has not been proved. Episiotomy does not protect the pelvic floor and does not reduce the incidence of urinary incontinence in women after childbirth. Conclusion: Obstetricians and midwives should maximally reduce perineal injuries. No study has yet proven a...

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Episiotomy and perineal tears presumed to be imminent: the influence on the urethral pressure profile, analmanometric and other pelvic floor findings – follow‐up study of a randomized controlled trial

Abstract: Episiotomy at a perineal tear presumed to be imminent does not have any advantage with regard to pelvic floor function and should be avoided.

Cited by 18 publications

References 31 publications

Selective versus routine use of episiotomy for vaginal birth

Selective versus routine use of episiotomy for vaginal birth

Influence of voluntary pelvic floor muscle contraction and pelvic floor muscle training on urethral closure pressures: a systematic literature review

Perineal trauma and its effect on the pelvic floor and urinary incontinence

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