Selective Episiotomy Compared With Implementation of a Nonepisiotomy Protocol

Abstract

INTRODUCTION:The utility and accuracy of hysterosalpingogram in a community hospital setting were evaluated for accuracy in predicting uterine cavity pathology.METHODS: A retrospective chart review was performed for all hysteroscopic procedures that had a hysterosalpingogram performed between August 1, 2012, and August 25, 2014, at a single community hospital in an inner-city setting. Hysterosalpingogram reports by a radiologist were reviewed, and hysteroscopy operative reports were reviewed that were performed by a reproductive endocrinologist. RESULTS:A total of 60 patients were identified. Average age was 31.3 years (median 34 years). Findings correlated for tubal diagnosis in 88.4% of patients. However, for uterine cavity defects, the accuracy was lowest for the finding of uterine septum on hysteroscopy; hysterosalpingogram reported normal findings on all six patients encountered in this series. High sensitivity and correlation were found for findings of intrauterine adhesions (95%), submucosal myomas, and endometrial polyps (90%). The findings for submucosal myomas and endometrial polyps were confirmed with final pathology.CONCLUSION: Hysterosalpingogram has a low sensitivity for finding of uterine septum in this setting. Further studies are needed for correlation with clinical impression by a reproductive endocrinologist.INTRODUCTION: Reproductive health care providers need recommendations on applications (apps) for patient use, particularly apps for menstrual cycle and fertility tracking, because these apps are frequently downloaded by women and can be used by clinicians when evaluating menstrual problems. METHODS: We searched PubMed and OVID MEDLINE for literature on women's reproductive health apps and searched the Apple iTunes store for menstrual cycle and fertility tracking apps. We recorded price, user rating, functionality, and whether an app was developed or recommended by medical experts. RESULTS:We identified six articles, all published since 2012, that discuss apps for patient use regarding women's reproductive health; none focused specifically on menstrual cycle or fertility tracking. The apps search identified 94 unique apps for menstrual cycle tracking, priced from free to $16.99. Sixteen (17%) free apps also had paid versions. User ratings ranged from 1.5-4.5 of 5 stars. App functionality included the ability to create a password (43%), tailor for irregular cycles (23%), back up or restore data (22%), select a pregnancy mode (20%), export or e-mail data (10%), or connect to social media (7%).

Selective versus routine use of episiotomy for vaginal birth

“…We excluded a total of 16 studies (Amorim 2015; Coats 1980; Detlefsen 1980; Dong 2004; El-Din 2014; Golmakani 2011; Henriksen 1992; Islam 2013; Javed 2007; Karbanova 2013; Moini 2009; Roy 2015; Sawant 2015; Shembekar 2009; Swift 2014; Werner 1991). …”

“…For details of excluded studies, see table of Characteristics of excluded studies . The main reason for exclusion (12 studies) was that studies did not compare selective versus routine use of episiotomy; rather they compared policies of no episiotomy versus selective episiotomy or different techniques for carrying out episiotomy ( Amorim 2015 ; Detlefsen 1980 ; Dong 2004 ; El‐Din 2014 ; Islam 2013 ; Javed 2007 ; Karbanova 2013 ; Moini 2009 ; Roy 2015 ; Sawant 2015 ; Swift 2014 ; Werner 1991 ). Two studies were quasi‐randomised trials ( Coats 1980 ; Henriksen 1992 ).…”

Cuidado da enfermagem durante o trabalho de parto e parto

“…Atualmente o uso rotineiro da episiotomia é contraindicado e os estudos corroboram para um uso seletivo. Não existem evidências que levem a considerar a episiotomia como necessária 15,16…”