Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy

Abstract

Objective To compare two policies for episiotomy: restrictive and systematic.Design Quasi-randomised comparative study.Setting Two French university hospitals with contrasting policies for episiotomy: one using episiotomy restrictively and the second routinely.Population Seven hundred and seventy-four nulliparous women delivered during 1996 of a singleton in cephalic presentation at a term of 37-41 weeks.Methods A questionnaire was mailed 4 years after delivery. Sample size was calculated to allow us to show a 10% difference in the prevalence of urinary incontinence with 80% power.Main outcome measures Urinary incontinence, anal incontinence, perineal pain, and pain during intercourse.Results We received 627 responses (81%), 320 from women delivered under the restrictive policy, 307 from women delivered under the routine policy. In the restrictive group, 186 (49%) deliveries included mediolateral episiotomies and in the routine group, 348 (88%). Four years after the first delivery, there was no difference in the prevalence of urinary incontinence (26 versus 32%), perineal pain (6 versus 8%), or pain during intercourse (18 versus 21%) between the two groups. Anal incontinence was less prevalent in the restrictive group (11 versus 16%). The difference was significant for flatus (8 versus 13%) but not for faecal incontinence (3% for both groups). Logistic regression confirmed that a policy of routine episiotomy was associated with a risk of anal incontinence nearly twice as high as the risk associated with a restrictive policy (OR = 1.84, 95% CI: 1.05-3.22).Conclusions A policy of routine episiotomy does not protect against urinary or anal incontinence 4 years after first delivery.

Prevalência de incontinência urinária autorreferida no pós-parto e fatores relacionados

“…A study conducted in the Midlands, with 2,100 participants, investigated the incidence of perineum morbidity in the postpartum showed that women who experienced perineum continuity of solution had greater representation for perineum morbidity than those who remained with perineum integrity (14) . The results of this study showed that routine usage of episiotomy does not seem to have protected the interviewees from suffering UI in the postpartum, these results were also found in a research conducted in France (10) .…”

Routine Episiotomy Causes More Morbidity in Parous Women, a Case Controlled Study Conducted in Kannur Medical College

“…Study by Fritel X reveals a policy of routine episiotomy does not protect against urinary or anal incontinence four years after first delivery. [9] Study by Chang shows episiotomy increased pain at weeks 1, 2 and 6 postpartum and urinary incontinence at 3 months postpartum. [12] The conclusion is after a prospective follow-up study of 243 women who completed the Taiwanese versions of the Short Form McGill Pain Questionnaire, International Consultation on Incontinence QuestionnaireUrinary Incontinence Short Form, Female Sexual Function Index and a demographic questionnaire after vaginal delivery in a Taiwanese Medical Center.…”

“…Another advantage of episiotomy that prevents pelvic organ prolapse also has been questioned. [9] Instead of preventing 3° and 4° perineal tear, episiotomy is responsible for 3° and 4° perineal tear. Traditionally, physicians have used episiotomies to minimize perineal trauma and postpartum pelvic floor dysfunction.…”

Incontinência urinária autorreferida no pós-parto: características clínicas

“…The calculation is obtained by multiplying the frequency of the urine losses (1 = less than once a month; 2 = once or twice a month; 3 = one or several times a week; 4 = every day and/or night) by the amount of urine loss each time (1 = drops; 2 = small amount; 3 = large amount). According to the resulting index (1 to 12), incontinence is classified into mild (1 to 2), moderate (3 to 6), severe (8 to 9) or very severe (12).…”

“…The present study addressed UI in the postpartum period, as there is scarce national literature regarding this morbidity in this phase of the pregnancypuerperium cycle. In literature, studies state that urinary incontinence affect up to 74% of the formerly continent pregnant women (10)(11)(12) . Considering a population of age between 17 and 45 years, studies show UI prevalence in the postpartum between 20% and 27.5% (10,(12)(13)(14)(15) .…”