The role of episiotomy in prevention of genital lacerations during vaginal deliveries – results from two european centers

Laganà, Antonio Simone; Terzić, Milan; Dotlić, Jelena; Sturlese, Emanuele; Palmara, Vittorio; Retto, Giovanni; Kocijancic, Dusica

doi:10.17772/gp/2058

Cited by 18 publications

(16 citation statements)

References 20 publications

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“…12 In the same time period, the episiotomy rate decreased from 35.9% to 26.4%. As supported by the literature, we found operative vaginal delivery 7,8,[13][14][15] to be an independent risk factor for sphincter damage. In particular, forceps delivery has consistently been shown to represent one of the major risk factors for obstetric anal sphincter injuries.…”

Section: Discussionsupporting

confidence: 80%

“…In line with most other reports, we found that high birthweight is a significant risk factor. 7,8,[13][14][15] Nevertheless, although the risk of obstetric anal sphincter injuries was 5 times higher when birthweight was >4000 g, the use of mediolateral episiotomy did not markedly reduce the risk, with a number needed to treat of 1000.…”

Section: Adjusted a Or (95% Ci)mentioning

confidence: 98%

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Risk and protective factors for obstetric anal sphincter injuries: A retrospective nationwide study

Marschalek

Worda

Kuessel

et al. 2018

Birth

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BackgroundIn view of the reported increase in obstetric anal sphincter injuries, the objective of this study was to evaluate the incidence of such injuries over time and the associated risk and protective factors.MethodsThis was a retrospective cohort study from a national database of 168 137 primiparous women with term, singleton, cephalic, vaginal delivery between 2008 and 2014. The main outcome measure was obstetric anal sphincter injury. A multivariate regression model was used to identify risk and protective factors.ResultsAge >19 years, birthweight >4000 g, and operative vaginal delivery were independent risk factors for obstetric anal sphincter injuries. Mediolateral episiotomy increased the risk for obstetric anal sphincter injuries in spontaneous vaginal birth (number needed to harm 333), whereas it was protective in vacuum delivery (number needed to treat 50). From 2008 to 2014, there was an increase in the rate of obstetric anal sphincter injuries (2.1% vs 3.1%, P < .01), vacuum deliveries (12.1% vs 12.8%, P < .01), and cesarean delivery after labor (17.1% vs 19.4%, P < .01), while forceps deliveries (0.4% vs 0.1%, P < .01) and episiotomy rate decreased (35.9% vs 26.4%, P < .01).ConclusionsEpisiotomy may be a risk or protective factor depending on the type of episiotomy and the clinical setting in which it is used. Our study supports a restrictive use of mediolateral episiotomy in spontaneous vaginal deliveries. In vacuum deliveries mediolateral episiotomy may help prevent obstetric anal sphincter injuries.

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Section: Discussionsupporting

confidence: 80%

Section: Adjusted a Or (95% Ci)mentioning

confidence: 98%

Risk and protective factors for obstetric anal sphincter injuries: A retrospective nationwide study

Marschalek

Worda

Kuessel

et al. 2018

Birth

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“…As the literature shows, higher maternal age is associated with spontaneous seconddegree tears. [9][10][11][12] Many studies showed multiparity as a protective factor against perineal tears and a higher incidence of intact perineum. [13][14][15] Women in this study were mainly in their first pregnancy; however, after the multiple analysis, the chance of spontaneous perineal tear decreased for each previous vaginal childbirth.…”

Section: Discussionmentioning

confidence: 99%

Perineal Care and Outcomes in a Birth Center

Lopes

Leister

Riesco

2019

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Objective: to analyse the perineal outcomes in childbirth and post-partum perineal care in a freestanding birth centre. Method: a cross-sectional study, with data collection performed in the women’s birth records forms from Casa Angela, a freestanding birth centre, São Paulo, Brazil, in 2016-2017 (n=415). The following data was analysed: occurrence and perineal tear degree; maternal, neonatal and birth care-related variables; perineal suture prevalence; complications in wound healing and natural methods on perineal care. Data were subjected to descriptive, inferential and multiple analyses. Results: in 11.8% of women, the perineum was kept intact, 61.9% had spontaneous first-degree tear and 26.3% had second-degree tear. The variables related to the occurrence and higher spontaneous degree tears were maternal age and second period of childbirth >2 hours. The protective factors against the occurrence and higher degree tears were number of previous vaginal childbirths and maternal position different from vertical during childbirth. Perineal suture was performed in 16.0% and 70.6% of women with spontaneous first- and second-degree tears, respectively. The main perineal complications after birth were edema (53.6%) and pain (29.4%); and the perineal suture increased the chance for these complications (OR=2.5; 95%CI 1.5-4.3). Perineum icepack compress was used in 53.8% of women during post-partum period. Conclusion: maternal and health-care related factors were associated to the prevalence and degree of spontaneous perineal tear. First-degree spontaneous perineal tears were prevalent and sutured in a low number of women. There were more complications in the wound healing process when the perineal suture was performed, regardless the tear degree. The number of natural methods in post-partum perineal care was higher than the use of medicines.

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“…Epizyotominin sadece fetal risk veya maternal distres endikasyonlarında doğumu hızlandırmak için kullanılabileceği ve epizyotomide mediolateral yönteminin (A düzeyi) tercih edilmesi önerilmiştir. [28,29,39,40] Doğumun taçlanma aşamasında PT'nın azaltılmasına etki eden bazı teknikler bulunmaktadır. Bunlar: "Manuel perine koruma modeli" bu yöntemde baş parmak ve işaret parmağı açıklığı sağlanarak perine korunur.…”

Section: İntrapartum Dönemunclassified

Current Approaches to the Prevention and Management of Postpartum Perineal Trauma

Erbaba¹,

Pınar²

2017

HEAD

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ÖZPerineal travma (PT) genital bölgede hemoroid, enfeksiyon, hematom, spontan laserasyon veya epizyotomi nedeniyle ortaya çıkan hasar olarak tanımlanmaktadır ve sıklıkla perineal ağrıya neden olmaktadır. PT'nın önlenmesi ve yönetimine yönelik farmakolojik yöntemlerin yanı sıra son zamanlarda tamamlayıcı ve alternatif tıp tedavileri de kullanılmaktadır. Bu uygulamaların hastaları tedirgin etmeden kullanılabilmesi ve olumlu sonuçlar alınabilmesi için sağlık çalışanlarının konuyla ilgili farklı yöntemler hakkında donanımlı olmaları ve kliniğe dayalı multidisipliner araştırmaları yaygınlaştırmaları gerekmektedir. Bu makalede, perineal travmanın önlenmesi ve yönetimine ilişkin kullanılan güncel yaklaşımlar kanıta dayalı çalışmalarla açıklanmaya çalışılmıştır. ABSTRACTPerineal trauma (PT) is de ned as damage due to hemorrhoids, infection, hematoma, spontaneous laceration or episiotomy in the genital area and frequently causes perineal pain. In addition to pharmacological methods for the prevention and management of PT, complementary and alternative medical treatments have been used recently. In order for these treatments to be used effectively on the patients and to obtain positive results, healthcare professionals should understand different methods related to the subject and should disseminate clinic-based multidisciplinary researches. In this article, current approaches to the prevention and management of perineal trauma are attempted to be explained with evidence-based studies.

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The role of episiotomy in prevention of genital lacerations during vaginal deliveries – results from two european centers

Cited by 18 publications

References 20 publications

Risk and protective factors for obstetric anal sphincter injuries: A retrospective nationwide study

Risk and protective factors for obstetric anal sphincter injuries: A retrospective nationwide study

Perineal Care and Outcomes in a Birth Center

Current Approaches to the Prevention and Management of Postpartum Perineal Trauma

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