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Parsy T, Bettiol C, Vidal F, Allouche M, Loussert-Chambre L, Guerby P. Persistent occiput posterior position: predictive factors of spontaneous rotation of the fetal head. J Matern Fetal Neonatal Med 2023; 36:2192854. [PMID: 37031965 DOI: 10.1080/14767058.2023.2192854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVES To assess factors associated with spontaneous rotation in the occiput anterior position for fetuses in persistent occiput posterior (OP) during the second stage of labor. To evaluate maternal and fetal outcomes after spontaneous rotation of persistent OP. METHODS This is a prospective cohort of 495 women with fetuses in persistent OP position, confirmed with ultrasonography during the second stage of labor. We performed simple logistic regressions, followed by multiple logistic regressions. RESULTS Among 495 women with fetuses in persistent OP position, 78 fetuses (16%) underwent a spontaneous rotation during the second stage of labor. The multivariate analysis found that a short duration of the first stage of labor (<7 h) was associated with a spontaneous rotation of the fetal head in the second stage of labor (OR 0.43 [0.23; 0.76. There were fewer episiotomies (25.6% vs 52.3%, p < .01), cesarean sections (0% v. 5.4%, p = .03), and instrumental deliveries (8.9% vs. 50%, p < .01) in the "spontaneous rotation" group, and the two groups were similar regarding post-partum hemorrhage.The newborns in the "spontaneous rotation" group had a higher Apgar score at 1 min (10 v. 9, p = .02). The two groups did not differ for other neonatal parameters, such as arterial pH value, Apgar score at 5 min, birth trauma, or transfer into the pediatric unit. CONCLUSION A shorter duration of the first stage of labor (< 7 h) is a predictive factor of spontaneous rotation in the occiput anterior position for fetuses in persistent OP position. A spontaneous rotation in case of an OP position is associated with better maternal and fetal outcomes.
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Affiliation(s)
- Thomas Parsy
- Gynecology and Obstetrics Departement, Paule de Viguier Maternity, CHU Toulouse, France
| | - Celia Bettiol
- Gynecology and Obstetrics Departement, Paule de Viguier Maternity, CHU Toulouse, France
| | - Fabien Vidal
- Gynecology and Obstetrics Departement, Paule de Viguier Maternity, CHU Toulouse, France
| | - Mickaël Allouche
- Gynecology and Obstetrics Departement, Paule de Viguier Maternity, CHU Toulouse, France
| | - Lola Loussert-Chambre
- Gynecology and Obstetrics Departement, Paule de Viguier Maternity, CHU Toulouse, France
| | - Paul Guerby
- Gynecology and Obstetrics Departement, Paule de Viguier Maternity, CHU Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases, Inserm UMR 1291 - CNRS UMR 5051 - University Toulouse III, France
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Riethmuller D, Mottet N, Guerby P, Parant O. [Spatulas: A Franco-Colombian story or the slow rise of propulsion...]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:143-152. [PMID: 36436820 DOI: 10.1016/j.gofs.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
The idea of using an instrument to assist natural childbirth is not new and it was in the 18th and 19th centuries that the forceps was developed. It is only after the Second World War that the suction cup provides an alternative to instrumental childbirth, but still based on prehension and traction. In 1950, Emile Thierry, in France, presented his spatulas based on the then original principle of propulsion. The diffusion of spatulas is almost non-existent in the Anglo-Saxon world but is not limited to France since its use was real by the Iberians and Latin Americans. There are currently three types of spatula, two of which are French and one Colombian. This review takes up the saga of this instrument for more than 70 years, develops its particularities and describes the present literature.
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Borges AC, Sousa N, Sarabando R, Vieira C, Ribeiro B, Barbosa P, Miranda A, Reis I, Nogueira-Silva C. Pelvic floor dysfunction after vaginal delivery: MOODS-a prospective study. Int Urogynecol J 2021; 33:1539-1547. [PMID: 34562133 DOI: 10.1007/s00192-021-04982-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Labor is a known risk factor for pelvic floor dysfunction (PFD); however, the impact of operative vaginal delivery (OVD), particularly spatulas, remains unclear. The aim of this study was to compare postpartum PFD symptoms in women undergoing spontaneous vaginal delivery (SVD) and those undergoing OVD. METHODS An observational prospective study (MOODS: Maternal-neonatal Outcomes in Operative Vaginal Delivery) was enrolled at Hospital de Braga from February to October 2018. All singleton term OVD (Thierry spatulas and vacuum extractor) and a convenience SVD sample were recruited, in a 2:1 ratio. To assess PFD symptoms Pelvic Floor Distress Inventory-20 (PFDI-20) was applied at 3, 6, and 12 months postpartum. The questionnaire is divided into three subscales: Urinary (UDI), Colorectal-Anal (CRADI), and Pelvic Organ Prolapse Distress Inventory (POPDI). RESULTS Of the 304 women recruited, 207 were included, 34.3% with SVD and 65.7% with OVD. Thierry spatulas were used in 53.7% of women undergoing OVD. Frequency of nulliparous (p < 0.001), episiotomy (p < 0.001), neuraxial anesthesia (p < 0.001), postpartum pain (p = 0.001) and occiput-posterior fetal position (p < 0.001) were significantly higher in OVD. Second phase of labor duration was longer in OVD (p = 0.001). At 3 months postpartum, women undergoing OVD and spatula-assisted delivery had higher UDI score, POPDI score, and global score, with no differences at 6 months and 1 year. After controlling for confounding variables, OVD and spatulas were still associated with greater POPDI scores at 3 months postpartum. CONCLUSIONS Operative vaginal delivery, particularly with spatulas, seems to be associated with a higher prevalence of early PFD symptoms, mainly regarding pelvic organ prolapse.
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Affiliation(s)
- Ana Catarina Borges
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal.
| | - Natacha Sousa
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Rita Sarabando
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Catarina Vieira
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Bárbara Ribeiro
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Paulina Barbosa
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Alexandra Miranda
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Isabel Reis
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Cristina Nogueira-Silva
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Wang X, Yang F, Chen W, Yuan X. Ultrasonic Diagnosis and Analysis of the Effect of Labor Analgesia on Early Pelvic Floor Function and Pelvic Floor Dysfunction. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pelvic floor dysfunction disease (PFD) is a common pelvic organ dysfunction disease in the clinic of obstetrics and gynecology. Its cause is mainly the damage, defects and dysfunction of the pelvic floor support structure. Not only is the pathogenesis complicated, but also various symptoms
coexist, which seriously affects the physical and mental health of female patients. Mechanical injury of the pelvic floor fascia tissue and levator ani muscles is the anatomical basis of PFD after birth; early postpartum pelvic floor examination and treatment can prevent and control the occurrence
or development of PFD. Spinal canal anesthesia has good analgesic effect during labor and delivery, has little effect on mothers and infants, and is widely used. However, there are few domestic and foreign reports on the effect of labor analgesia on the pelvic floor. Labor analgesia relaxes
the pelvic floor muscles, unblocks the birth canal, and the influence on the pelvic floor muscles is worth exploring. Based on the pelvic floor muscle strength screening to understand the changes in the function of the pelvic floor muscles, combined with the three-dimensional pelvic floor
ultrasound examination, the pelvic floor structure and the levator ani muscle are clearly imaged, and the pelvic floor muscle structure is evaluated in the natural state and the analgesic muscle relaxation state. This study used a combination of the two to evaluate the effect of labor analgesia
on pelvic floor function of primiparous women; provide individualized intervention treatment for high-risk groups screened; provide clinical basis for the prevention and treatment of PFD.
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Affiliation(s)
- Xiaolan Wang
- Department of Obstetrics, Maternal and Children's Health Care Hospital, Jiujiang, Jiangxi, 332000, China
| | - Fan Yang
- Department of Obstetrics, Maternal and Children's Health Care Hospital, Jiujiang, Jiangxi, 332000, China
| | - Wenjuan Chen
- Department of Ultrasound, Maternal and Children's Health Care Hospital, Jiujiang, Jiangxi, 332000, China
| | - Xiaohong Yuan
- Department of Pelvic Floor Rehabilitation, Maternal and Children's Health Care Hospital, Jiujiang, Jiangxi, 332000, China
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Cattani L, Neefs L, Verbakel JY, Bosteels J, Deprest J. Obstetric risk factors for anorectal dysfunction after delivery: a systematic review and meta-analysis. Int Urogynecol J 2021; 32:2325-2336. [PMID: 33787952 DOI: 10.1007/s00192-021-04723-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/04/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pregnancy and childbirth are considered risk factors for pelvic floor dysfunction, including anorectal dysfunction. We aimed to assess the effect of obstetric events on anal incontinence and constipation after delivery. METHODS We systematically reviewed the literature by searching MEDLINE, Embase and CENTRAL. We included studies in women after childbirth examining the association between obstetric events and anorectal dysfunction assessed through validated questionnaires. We selected eligible studies and clustered the data according to the type of dysfunction, obstetric event and interval from delivery. We assessed risk of bias using the Newcastle Ottawa Scale and we performed a random-effects meta-analysis and reported the results as odds ratios (ORs) with their 95% confidence intervals. Heterogeneity across studies was assessed using I2 statistics. RESULTS Anal sphincter injury (OR: 2.44 [1.92-3.09]) and operative delivery were risk factors for anal incontinence (forceps-OR :1.35 [1.12-1.63]; vacuum-OR: 1.17 [1.04-1.31]). Spontaneous vaginal delivery increased the risk of anal incontinence compared with caesarean section (OR: 1.27 [1.07-1.50]). Maternal obesity (OR:1.48 [1.28-1.72]) and advanced maternal age (OR: 1.56 [1.30-1.88]) were risk factors for anal incontinence. The evidence on incontinence is of low certainty owing to the observational nature of the studies. No evidence was retrieved regarding constipation after delivery because of a lack of standardised validated assessment tools. CONCLUSIONS Besides anal sphincter injury, forceps delivery, maternal obesity and advanced age were associated with higher odds of anal incontinence, whereas caesarean section is protective. We could not identify obstetric risk factors for postpartum constipation, as few prospective studies addressed this question and none used a standardised validated questionnaire.
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Affiliation(s)
- Laura Cattani
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - Liesbeth Neefs
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - Jan Y Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jan Bosteels
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Obstetrics and Gynaecology Unit, Imelda Hospital, Bonheiden, Belgium.,CEBAM, The Centre for Evidence-based Medicine, Cochrane Belgium, Academic Centre for General Practice, Leuven, Belgium
| | - Jan Deprest
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium. .,Research Department of Maternal Fetal Medicine, Institute for Women's Health, University College London, London, UK.
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Lebraud M, Griffier R, Hmila S, Aubard Y, Gauthier T, Parant O, Guerby P. Comparison of maternal and neonatal outcomes after forceps or spatulas-assisted delivery. Eur J Obstet Gynecol Reprod Biol 2020; 258:126-131. [PMID: 33421809 DOI: 10.1016/j.ejogrb.2020.12.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to compare the perinatal outcomes associated with spatulas or forceps assisted delivery. STUDY DESIGN This is a bicentric retrospective cohort study including all assisted deliveries in cephalic presentation after 37 weeks of gestation, performed on singleton pregnancy with forceps and with spatulas in two tertiary centers. The main outcome was the rate of episiotomy. Secondary outcomes included obstetric anal sphincter injuries (OASIS), maternal outcomes and neonatal parameters. RESULTS Out of 37 002 deliveries, the overall rate of assisted delivery was 11.4 %, and 1 041 (2.8 %) assisted deliveries with forceps and 2 462 (6.7 %) spatulas deliveries were included. The rate of episiotomy was 90.3 % after forceps-assisted delivery and 70.9 % for spatulas (p < 0.001). The rate of OASIS was 7.2 % and 5.6 % respectively (p = 0.06). A slight but significant decrease in neonatal trauma after spatulas was observed. CONCLUSION In this retrospective cohort study, the episiotomy rate was higher with forceps assisted deliveries than with spatulas. Both instruments have low neonatal morbidity and are similar regarding OASIS.
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Affiliation(s)
- Margaux Lebraud
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France
| | - Romain Griffier
- Department of Public Health, CHU Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France
| | - Salwa Hmila
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Yves Aubard
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Tristan Gauthier
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France; Université Paul-Sabatier Toulouse III, 31330 Toulouse, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France; Université Paul-Sabatier Toulouse III, 31330 Toulouse, France.
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7
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Dole C, Metz JP, Formet J, Riethmuller D, Ramanah R, Mottet N. Intra pelvic spontaneous rotation of persistent occiput posterior position in case of operative vaginal delivery with spatulas. J Gynecol Obstet Hum Reprod 2020; 50:101943. [PMID: 33069912 DOI: 10.1016/j.jogoh.2020.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In 5 % of vaginal deliveries in case of cephalic presentation there is a persistent occipital posterior position known to be associated with a higher maternal and neonatal morbidity. In these situations, vacuum extractor seems to be the best choice for assisted delivery but it also has limits and contraindications, for example an important caput succadenum or premature birth. The aim of our study was to evaluate the rate of intra-pelvic rotation of persistent occipital posterior position without instrumental rotation in case of operative delivery with spatulas. METHODS This is a retrospective, monocentric and descriptive study evaluating the rate of spontaneous intra-pelvic rotation of persistent occipital posterior position in case of assisted delivery with spatulas among all live births at the Besançon University Medical Center between 2010 and 2017. RESULTS There were 20 205 births during the study and 81(0,4 %) operative deliveries by spatulas in case of persistent occipital posterior position. Delivery in occiput anterior (OA) position was obtained in 36 cases (44.4 %). There was no significant difference in maternal or neonatal morbidity between both groups and perineum injuries were less severe in case of OA delivery. CONCLUSION Operative deliveries by spatulas without instrumental rotation in case of persistent occipital-posterior position seem to be a relevant alternative to vacuum extractor, especially in case of premature birth or important caput succedaneum without altering the maternal or neonatal prognostic.
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Affiliation(s)
- Chloé Dole
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France.
| | - Jean Patrick Metz
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Justine Formet
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Didier Riethmuller
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Rajeev Ramanah
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Nicolas Mottet
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
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8
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Marguier Blanchard I, Metz JP, Eckman Lacroix A, Ramanah R, Riethmuller D, Mottet N. [Manual rotation in occiput posterior position: A systematic review in 2019]. ACTA ACUST UNITED AC 2019; 47:672-679. [PMID: 31200108 DOI: 10.1016/j.gofs.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the safety and the benefits of manual rotation in the management of Occiput-posterior positions in 2019. METHODS A systematic review of literature was performed using the MEDLINE and COCHRANE LIBRARY databases, in order to identify articles concerning maternal and neonatal outcomes after a manual rotation, through January 2019. Information on study characteristics (review, author, year of publication), population, objectives and main neonatal and maternal outcomes were extracted. RESULTS A total of 51 articles were identified and 12 articles were selected for the systematic review. The rate of successful manual rotation were about 47 to 90%. There were more success if systematic manual rotation, multiparity, engagement, spontaneous labour and maternal age<35. The 2nd stage of labour was shorter after an attempt of manual rotation. The randomised controlled trials did not find any statistical difference concerning operative deliveries or neonatal and maternal outcomes. CONCLUSION The manual rotation is an obstetrical manoeuvre which must be regulated and only practiced by trained operators. Currently, the state of science is not sufficient to recommend the manual rotation as a systematic practice in 2019.
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Affiliation(s)
- I Marguier Blanchard
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France.
| | - J-P Metz
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France
| | - A Eckman Lacroix
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France
| | - R Ramanah
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France
| | - D Riethmuller
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France
| | - N Mottet
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France.
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Boujenah J, Tigaizin A, Fermaut M, Murtada R, Benbara A, Benchimol M, Pharisien I, Carbillon L. Is episiotomy worthwile to prevent obstetric anal sphincter injury during operative vaginal delivery in nulliparous women? Eur J Obstet Gynecol Reprod Biol 2018; 232:60-64. [PMID: 30468985 DOI: 10.1016/j.ejogrb.2018.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Episiotomy is a marker of Obstetric Anal Sphincter Injury (OASIS) condition, therefore, unmeasured factors could have biased the strength of the association between episiotomy and reduced OASIS during Operative Vaginal Delivery (OVD). The aim of this study was to compare the OASIS rate during OVD according to episiotomy practice. STUDY DESIGN Retrospective cohort study of all nulliparous pregnant women attempting an OVD between 2014-2017. To avoid unmeasured bias, all maternal and delivery data were prospectively captured after the birth. The strong relationship between parity and episiotomy practice (indication bias) lead to analyze only nulliparous women. Association between mediolateral episiotomy and OASIS following OVD was performing by using multivariate logistic regression analysis including significant variable in univariate analysis and relevant factors known to be associated both with OASIS and/or OVD. RESULTS Over the study period, 1709 (17.1%) women had an OVD, among them 40 (2.3%) had OASIS. In the 1342 (78.5%) nulliparous women, OASIS rate were 2% and 5.1% with and without episiotomy (p < 0.01). In multivariate analysis a lower incidence of OASIS with the use of episiotomy (OR 0.267 IC 0.132-0.541) were observed. The persistent occiput posterior position was associated with an increase risk of OASIS (OR 6.742 IC 2.376-19.124). Spatula/forceps, as compared to vacuum operative vaginal delivery increased the risk OASIS (OR 2.847 IC 1.311-7.168). Area under the curve of the model was 0.745. CONCLUSION Episiotomy is a modifiable risk factors which can contribute to reduce the risk of OASIS in nulliparous women with operative vaginal delivery. This intervention should be included in a global management of the second stage of labor.
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Affiliation(s)
- J Boujenah
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93000, Bobigny, France.
| | - A Tigaizin
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France
| | - M Fermaut
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France
| | - R Murtada
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France
| | - A Benbara
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France
| | - M Benchimol
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France
| | - I Pharisien
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93000, Bobigny, France
| | - L Carbillon
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93000, Bobigny, France
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