Évaluation d’une politique restrictive d’épisiotomie avant et après les recommandations du Collège national des gynécologues obstétriciens français

Eckman, A.; Ramanah, R.; Gannard, E.; Clément, Marc; Collet, G.; Courtois, Luc; Martin, A.; Cossa, S.; Maillet, R.; Riethmuller, Didier

doi:10.1016/j.jgyn.2009.09.013

Cited by 38 publications

(10 citation statements)

References 18 publications

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“…Ce travail avait permis de constater un net recul du recours à l'épisiotomie (54,2 % vs 22,7 %) sans induire pour autant de morbidité maternofoetale évidente. Une étude similaire à la nôtre, réalisée par l'équipe obstétricale de Besançon retrouvait une diminution du taux global d'épisiotomies, celui-ci passant de 18,8 à 3,4 %, sans augmentation du taux de lésions périnéales des troisième et quatrième degré [3]. Bien qu'il s'agisse d'une étude de faible puissance menée sur une courte période et sur de faibles effectifs, ce chiffre laisse à penser que l'on pourrait encore réduire notre taux sans induire de morbidité supplémentaire.…”

Section: Discussionunclassified

“…Dans une revue de littérature récente, analysant 12 études de cohortes, les prévalences de déchi-rures périnéales du troisième et quatrième degré variaient de 4 à 33 % en cas de forceps et de 2 à 28 % en cas de ventouse pour des OR respectivement de 1,5 à 27 et de 2 à 28 par rapport à la voie basse spontanée [20]. Dans l'étude bisontine, le taux d'épisiotomies est particulièrement bas, même en cas d'EI (9,6 % d'épisiotomies en 2007 pour les EI, tous types confondus et 10 % pour les extractions par ventouse), sans augmentation du taux de déchirures périnéales sévères (8‰ pour les déchirures du troisième degré et 4‰ pour les déchirures du quatrième degré) [3]. Au terme de notre étude, même si les actions mises en place en vue de diminuer la pratique de l'épisiotomie commencent à aboutir, nos efforts doivent être poursuivis.…”

Section: Patientes Et Méthodesunclassified

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De l’impact des RPC pour réduire le taux d’épisiotomie

Reinbold

Eboue

Morello

et al. 2012

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

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Section: Discussionunclassified

Section: Patientes Et Méthodesunclassified

De l’impact des RPC pour réduire le taux d’épisiotomie

Reinbold

Eboue

Morello

et al. 2012

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

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“…17,18 They found that the recommendations of the CNGOF to restrict the use of episiotomy led to a dramatic decrease in the episiotomy rate (in the first study from 19% to 3% between 2003 and 2007 (17) and in the second study from 56% to 13% between 2004 and 2009 18 without any significant increase in severe vaginal tears (third and fourth degree) or sequelae (p<0.01).…”

mentioning

confidence: 97%

Reasons for routine episiotomy: A mixed-methods study in a large maternity hospital in Phnom Penh, Cambodia

Schantz¹,

Sim

et al. 2015

Reproductive Health Matters

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First documented in 1741, the practice of episiotomy substantially increased worldwide during the 20th century. However, research shows that episiotomy is not effective in reducing severe perineal trauma and may be harmful. Using a mixed-methods approach, we conducted a study in 2013-14 on why obstetricians and midwives in a large maternity hospital in Phnom Penh, Cambodia, still do routine episiotomies. The study included the extent of the practice, based on medical records; a retrospective analysis of the delivery notes of a random sample of 365 patients; and 22 in-depth interviews with obstetricians, midwives and recently delivered women. Of the 365 women, 345 (94.5%, 95% CI: 91.7-96.6) had had an episiotomy. Univariate analysis showed that nulliparous women underwent episiotomy more frequently than multiparous women (OR 7.1, 95% CI 2.0-24.7). The reasons given for this practice by midwives and obstetricians were: fear of perineal tears, the strong belief that Asian women have a shorter and harder perineum than others, lack of time in overcrowded delivery rooms, and the belief that Cambodian women would be able to have a tighter and prettier vagina through this practice. A restrictive episiotomy policy and information for pregnant women about birthing practices through antenatal classes should be implemented as soon as possible.

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“…Another factor is how much con dence and trust is placed in governing bodies and national guidelines (42). Dramatic decreases in the episiotomy rate in France were attributed to the College of Obstetricians and Gynecologists (CNGOF) because its clinical practice guidelines clearly advocated for a policy of restrictive episiotomy (57,58). In contrast, the wording of the 2016 'O cial Norm' for Mexico remains purposefully vague and supports the provider to use their clinical judgement (22).…”

Section: Discussionmentioning

confidence: 99%

Health care workers’ perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico

Garcia-Cerde

Torres‐Pereda

Olvera-García

et al. 2020

Preprint

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Background Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how health personal, at four community hospitals in Mexico, perceive episiotomy, both before and after training in respectful maternity care, obstetric and neonatal emergencies. Methods This is a descriptive and interpretative qualitative study. We conducted Fifty-three pre and post-intervention (PRONTO© Program) semi-structured interviews with generalists, specialists and nurses (N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories. Results Themes fell into six major themes surrounding their perceptions of episiotomy: as a predictable practice, as a prophylactic intervention, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of medical personnel. Conclusions Perceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this and other harmful obstetrical practices.

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Évaluation d’une politique restrictive d’épisiotomie avant et après les recommandations du Collège national des gynécologues obstétriciens français

Cited by 38 publications

References 18 publications

De l’impact des RPC pour réduire le taux d’épisiotomie

De l’impact des RPC pour réduire le taux d’épisiotomie

Reasons for routine episiotomy: A mixed-methods study in a large maternity hospital in Phnom Penh, Cambodia

Health care workers’ perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico

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