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Alsuraykh LA, Alnadawi AA, Alharbi A, Alhumaidi KA, Alhabardi N, Almarshud R. Women's Perceptions and Knowledge Toward Episiotomy in Qassim Region, Saudi Arabia. Cureus 2024; 16:e55383. [PMID: 38562338 PMCID: PMC10984130 DOI: 10.7759/cureus.55383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Episiotomy, despite being one of the most common interventions during childbirth, carries significant risks and uncertain benefits. Previous global studies highlight varying awareness levels and practices, with decreasing episiotomy rates attributed to increased knowledge. This study aims to assess women's knowledge to enhance intrapartum decision-making and communication between patients and obstetricians, ultimately improving maternal outcomes in the region. METHODOLOGY The study was a cross-section design. It was conducted through an online survey that was distributed by different social media platforms (Twitter, WhatsApp, and Telegram) from February 2023 to January 2024. It included women living in the Qassim region, Saudi Arabia, who were 15 years old or older. Data was analyzed using the SPSS program (IBM, Chicago, Illinois, USA). RESULTS Among the 402 participants, 62.7% demonstrated awareness of episiotomy, with 94.0% accurately identifying it as a surgical cutting with scissors. About 82.5% acknowledged that not all women require episiotomies, while 48.8% recognized the necessity of anesthesia before the procedure. Understanding the indications for episiotomy varied, with facilitating and accelerating childbirth (64.3%) and dealing with a large baby (62.3%) being the most recognized reasons. Impressively, 90.5% believed that there are methods to avoid perineal cutting, with knowing the correct mechanism for pushing during childbirth (69.4%) and exercise (54.4%) being the most acknowledged preventive measures. Regarding post-cutting care, antibiotics (61.5%) were identified as essential, followed by analgesia (52.8%) and laxatives (48.8%). CONCLUSION The study reveals a notable awareness among participants, with a majority demonstrating a solid understanding of the procedure, its indications, and post-procedure care. It identified specific knowledge gaps, such as the need for anesthesia awareness and divergent beliefs about post-episiotomy care practices.
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Affiliation(s)
- Lubna A Alsuraykh
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Aseel A Alnadawi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Aeshah Alharbi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Kadi A Alhumaidi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Nadiyah Alhabardi
- Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Raghad Almarshud
- General Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
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Faden YA, Fatani AM, Fallatah BM, Rawa TS, Almasri SA, El Amin NO, Rawas SA, Al-Hindi MY. Examining the Association Between Episiotomy and Severe Perineal Tears in a Tertiary Care Center Implementing a Restrictive Episiotomy Policy. Cureus 2022; 14:e31606. [DOI: 10.7759/cureus.31606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 11/19/2022] Open
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Garcia-Cerde R, Torres-Pereda P, Olvera-Garcia M, Hulme J. Health care workers' perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico. BMC Pregnancy Childbirth 2021; 21:549. [PMID: 34384395 PMCID: PMC8359587 DOI: 10.1186/s12884-021-04022-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
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 and why this practice persists despite shifts in knowledge and attitudes facilitated by the implementation of an obstetric training program. METHODS This is a descriptive and interpretative qualitative study. We conducted 53 pre and post-intervention (PRONTO© Program) semi-structured interviews with general physician, gynecologists 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 five major themes surrounding their perceptions of episiotomy: as a preventive measure, 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 health care providers. 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 harmful obstetrical practice.
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Affiliation(s)
- Rodrigo Garcia-Cerde
- Departamento de Salud Reproductiva (Department of Reproductive Health), Centro de Investigación en Salud Poblacional (Center for Research in Population Health), Instituto Nacional de Salud Pública de México (National Institute of Public Health of Mexico), Av. Universidad 655, Col. Sta. Maria Ahuacatitlán. Cp, 62100, Cuernavaca, Morelos, Mexico
| | - Pilar Torres-Pereda
- Dirección de Investigación en Equidad para la Salud (Health Equity Research Department), Centro de Investiación en Sistemas de Salud (Center for Health Systems Research), Instituto Nacional de Salud Pública de México (National Institute of Public Health of Mexico), Av. Universidad 655, Col. Sta. Maria Ahuacatitlán. Cp, 62100, Cuernavaca, Morelos, Mexico
| | - Marisela Olvera-Garcia
- Departamento de Salud Reproductiva (Department of Reproductive Health), Centro de Investigación en Salud Poblacional (Center for Research in Population Health), Instituto Nacional de Salud Pública de México (National Institute of Public Health of Mexico), Av. Universidad 655, Col. Sta. Maria Ahuacatitlán. Cp, 62100, Cuernavaca, Morelos, Mexico
| | - Jennifer Hulme
- Department of Family and Community Medicine, University of Toronto, Toronto General Hospital, University Health Network, 200 Elizabeth Street, R. Fraser Elliott Building, Ground Floor, Room 480, Toronto, ON, M5G 2C4, Canada.
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Clesse C, Cottenet J, Lighezzolo-Alnot J, Goueslard K, Scheffler M, Sagot P, Quantin C. Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries. Sci Rep 2020; 10:20208. [PMID: 33214621 PMCID: PMC7677317 DOI: 10.1038/s41598-020-70881-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/28/2020] [Indexed: 02/08/2023] Open
Abstract
Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N = 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p < 0.01), and from 15.5 to 9.3% (p < 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥ 4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks.
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Affiliation(s)
- Christophe Clesse
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary, University of London, Old Anatomy Building Charterhouse Square, London, EC1M 6BQ, UK.,Interpsy Laboratory (EA 4432), Universite de Lorraine - Campus Lettres Et Sciences Humaines, Nancy, France.,Majorelle Polyclinic, Nancy, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France
| | | | - Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France
| | - Michele Scheffler
- Obstetricial Gynecologist, Endocrinologist, Gynecologist, The FNCGM (National Federation of Gynecology Medical Colleges), Cabinet de Gynécologie Médicale Et Obstétrique, 21 avenue Foch, 54000, Nancy, France
| | - Paul Sagot
- Department of Obstetrics and Gynecology, University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France. .,Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France. .,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
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Jung A, Reheis L, Host A, Hummel M, Billing M, Garbin O. [Retrospective evaluation of relevance of care in the management of presumed benign ovarian tumors]. ACTA ACUST UNITED AC 2020; 48:491-499. [PMID: 32243912 DOI: 10.1016/j.gofs.2020.03.020] [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: 02/03/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The relevance of care is defined by the right act, for the right patient, at the right time. We were interested in the relevance of the management of presumed benign ovarian tumors before and after the release of the CNGOF guidelines 2013 (French guidelines). METHODS This is a retrospective observational study conducted at the University Hospital in Strasburg France from 01/01/2013 to 31/12/2017 including all patients treated for a presumed benign ovarian cyst. We were interested in the diagnostic approach: relevance of the prescribed imaging and the use of CA 125 dosage, in the therapeutic approach: the relevance of the technique used as well as the relevance of the surgical indication. We compared our practices between 2013 and 2017 for these same items. RESULTS We included 682 cysts for 621 patients, the imaging performed was relevant in 55% of cases, not relevant but justified in 25% and irrelevant in 20%. The CA 125 assay or its absence of assay was relevant in 84% of cases. The surgical technique was relevant in 67% of cases and not relevant but justified in 29%. With a significant improvement 7.1% in 2013 of irrelevant against 0.9% for the year 2017. The surgical indication was relevant in 72% of cases, not relevant but justified in 20% and irrelevant in 2.7%. CONCLUSIONS The analysis of the relevance of care allows an evaluation of our practices. Professional recommendations can have an impact on the quality of care.
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Affiliation(s)
- A Jung
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur , BP 120, 67303 Schiltigheim, France.
| | - L Reheis
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur , BP 120, 67303 Schiltigheim, France
| | - A Host
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur , BP 120, 67303 Schiltigheim, France
| | - M Hummel
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur , BP 120, 67303 Schiltigheim, France
| | - M Billing
- Direction qualité, hôpitaux universitaires, Strasbourg, France
| | - O Garbin
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur , BP 120, 67303 Schiltigheim, France
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Goueslard K, Cottenet J, Roussot A, Clesse C, Sagot P, Quantin C. How did episiotomy rates change from 2007 to 2014? Population-based study in France. BMC Pregnancy Childbirth 2018; 18:208. [PMID: 29866103 PMCID: PMC5987447 DOI: 10.1186/s12884-018-1747-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 04/19/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Since the 2000s, selective episiotomy has been systematically recommended worldwide. In France, the recommended episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with episiotomy. METHODS This population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with episiotomy for non-operative vaginal deliveries and the risk factors related to the women's characteristics and the birth environment. RESULTS There were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23-1.30]), epidural analgesia (aOR = 1.45 [1.43-1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47-1.49]), and giving birth for the first time (aOR = 3.85 [3.84-4.00]). CONCLUSIONS The episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant.
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Affiliation(s)
- Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Christophe Clesse
- Laboratoire interpsy (EA4432), université de Lorraine, Nancy 2, 3, place Godeffroy-de-Bouillon, 54000 Nancy, France
- Centre hospitalier de Jury-les-Metz, route d’Ars-Laquenexy, 57073 Jury-Les-Metz cedex 03, BP 75088 Nancy, France
| | - Paul Sagot
- Gynecology Obstetrics Center, François-Mitterrand Hospital, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
- Inserm, CIC 1432, Dijon, France; Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon, France
- Inserm, CIC 1432, Dijon, France ; Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon, France
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Gebuza G, Kaźmierczak M, Gdaniec A, Mieczkowska E, Gierszewska M, Dombrowska-Pali A, Banaszkiewicz M, Maleńczyk M. Episiotomy and perineal tear risk factors in a group of 4493 women. Health Care Women Int 2018; 39:663-683. [PMID: 29648935 DOI: 10.1080/07399332.2018.1464004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Episiotomy belongs to the most frequent procedures carried out during delivery. Performing episiotomy should be reduced as there is scientific evidence indicating that it can cause pain, sexual problems, and serious, long-term health consequences. The aim of the researchers is to identify factors associated with episiotomy and the perineal tear. Analyses were performed using a model of a logistic regression. The study involved 4493 women. The episiotomy risk was related to: a birth weight exceeding 3500 grams, an instrumental delivery by means of forceps or vacuum extraction. The decrease of episiotomy rate increased the rate of perineal tear of first and second degree. The study has shown that episiotomy protects women from third- and fourth-degree perineal tear.
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Affiliation(s)
- Grażyna Gebuza
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | - Marzena Kaźmierczak
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | - Alicja Gdaniec
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | - Estera Mieczkowska
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | | | | | | | - Marek Maleńczyk
- b Obstetrics, Feminine Health, and Oncologic Gynecology Unit, District Hospital , Torun , Poland
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Zaidan A, Hindi M, Bishara A, Alolayan S, Abduljabbar H. The Awareness Regarding the Episiotomy Procedure Among Women in Saudi Arabia. Mater Sociomed 2018; 30:193-197. [PMID: 30515058 PMCID: PMC6195407 DOI: 10.5455/msm.2018.30.193-197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Episiotomy is an intended incision made through the perineal body to enlarge the vaginal orifice during the second stage of labor to ease the parturition. A cross sectional study in Jeddah, Saudi Arabia, showed that 35% of the females in 2012 had an episiotomy, this slightly increased in 2015 to (36.4%). Given the increase rates of episiotomy and the significance of patients’ awareness, there were very limited data on the awareness of episiotomy among women. Aim: Aim of this study is to estimate the extent of the awareness regarding the episiotomy procedure among women in Saudi Arabia. Material and methods: Participants aged 15 and above filled a questionnaire distributed online to different regions of Saudi Arabia. Descriptive statistics were used. Results: a total of 626 women participated in this study with a mean age 34.7 years. The majority (63.6%) of women reported being informed about the procedure. Still, only (40%) of them were able to describe the procedure correctly. Only age, parity and history of previous episiotomy were predictors for episiotomy awareness. Women aged 35 or less were more aware of episiotomy than those aged more than 35 with a p-value (<0.001). However, the multigravida were more aware of episiotomy than primigravida with a p-value (< 0.001). Conclusion: The awareness of episiotomy is still not accomplish in Saudi Arabia, which poses the need for further modalities to educate women and increase their awareness regarding selective episiotomy rather than the old method of routine episiotomy.
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Affiliation(s)
- Asma Zaidan
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Muhab Hindi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Bishara
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Samar Alolayan
- Obstetrics and Gynecology Department, Faculty of Medicine, Jeddah University, Jeddah, Kingdom of Saudi Arabia
| | - Hassan Abduljabbar
- Obstetrics and Gynecology Department, Faculty of Medicine, Jeddah University, Jeddah, Kingdom of Saudi Arabia
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[Can the rate of episiotomy still be lowered? Status update in PACA region (south of France)]. ACTA ACUST UNITED AC 2017; 45:146-151. [PMID: 28682756 DOI: 10.1016/j.gofs.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/03/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate professional practices relative to episiotomies in the Provence Alpes Côte d'Azur (PACA) region by analysing their incidence in maternity hospitals, by type and by sector of activity. Following this, to analyse maternal and obstetric characteristics associated with episiotomies and the occurrence of perineal tears in Marseille's university hospitals (CHU). METHODS Data were extracted from the database for the period from 1st January 2012 to 31 December 2014. The sample included 41 maternity hospitals: 13 private and 28 public. Twenty of the maternity hospitals were level 1, 15 were level 2, and 2 were level 3 (Nice and AP-HM). RESULTS In the PACA region, 176,573 patients gave birth by vaginal delivery. The incidence of episiotomy over the 3 years was 21.6% (0.50% - 76.13%) with a statistically significant reduction in the incidence between 2012 and 2014 (P<0.001). There was a significant difference by sector (P<0.001) and level (P<0.001) of maternity hospitals. In the Marseille CHU, 21.6% of women had an episiotomy (66.4% in primiparas - 33.6% in multiparous) and 43% had perineal tears (62.3% in primiparas - 37.7% in multiparous). After multivariate analysis, gender, weight of the newborn, presentation, gestational age, and mode of delivery were shown to be factors significantly associated with occurrence of episiotomy and occurrence of perineal tear (P<0.001). CONCLUSION A significant decrease in the incidence of episiotomy was observed in the PACA region from 2012 to 2014, associated with a wide variation in rates depending on the maternity hospitals, their types and their sectors.
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Clesse C, Lighezzolo-Alnot J, Hamlin S, De Lavergne S, Scheffler M. [The practice of episiotomy in France 10 years after the recommendations of CNGOF: What inventory?]. ACTA ACUST UNITED AC 2016; 44:232-8. [PMID: 26997462 DOI: 10.1016/j.gyobfe.2016.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 02/09/2016] [Indexed: 12/14/2022]
Abstract
Since its creation, the practice of episiotomy has evolved, being influenced by several factors. Various stances on its use were stated, until the eventual reduction of this practice, as suggested by numerous practical guides. In 2005, the National College of Obstetricians and Gynecologists in France published its French Guidelines for Clinical practice in this area. Today, it seems appropriate to focus on the evolution of the use of episiotomy, ten years after the publication of these recommendations. The authors propose a literature review, browsing through all the available epidemiological data in France related to episiotomy, recording all national statistics and some local trends, as there are regional specificities. This review allows to follow the overall evolution of the practice of episiotomy in France between 1981 and 2014, and to identify territorial disparities. Finally, in the specific context of the practice of episiotomy in French gynecological and obstetrics field, the authors conclude it by considering the possible evolution of this surgical practice, as well as, the Clinical Practice Recommendations related to it.
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Affiliation(s)
- C Clesse
- Laboratoire interpsy (EA4432), université de Lorraine, Nancy 2, 3, place Godeffroy-de-Bouillon, 54000 Nancy, France; Centre hospitalier de Jury-les-Metz, route d'Ars-Laquenexy, BP 75088, 57073 Jury-Les-Metz cedex 03, France.
| | - J Lighezzolo-Alnot
- Laboratoire interpsy (EA4432), université de Lorraine, Nancy 2, 3, place Godeffroy-de-Bouillon, 54000 Nancy, France
| | - S Hamlin
- Polyclinique Majorelle, 1240, avenue Raymond-Pinchard, 54100 Nancy, France
| | - S De Lavergne
- Polyclinique Majorelle, 1240, avenue Raymond-Pinchard, 54100 Nancy, France
| | - M Scheffler
- Polyclinique Majorelle, 1240, avenue Raymond-Pinchard, 54100 Nancy, France; Cabinet de gynécologie médicale et obstétrique, 21, avenue Foch, 54000 Nancy, France
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Schantz C, Sim KL, Ly EM, Barennes H, Sudaroth S, Goyet S. Reasons for routine episiotomy: A mixed-methods study in a large maternity hospital in Phnom Penh, Cambodia. REPRODUCTIVE HEALTH MATTERS 2015; 23:68-77. [PMID: 26278834 DOI: 10.1016/j.rhm.2015.06.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/11/2015] [Accepted: 06/08/2015] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
- Clémence Schantz
- Centre Population & Développement (CEPED)-UMR 196: IRD (Institut de Recherche pour le Développement) and Université Paris Descartes, Paris, France.
| | | | - Ek Meng Ly
- Calmette Maternity Hospital, Phnom Penh, Cambodia
| | - Hubert Barennes
- ANRS (Agence Nationale de Recherche sur le VIH et les Hépatites), and Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia; Isped (Institut de Santé Publique d'Epidémiologie et de Développement), Centre INSERM (Institut National de la Santé et de la Recherche Médicale) U897-Epidemiologie-Biostatistique, Université de Bordeaux, Bordeaux, France
| | - So Sudaroth
- Calmette Maternity Hospital, Phnom Penh, Cambodia
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Sagi-Dain L, Sagi S. Morbidity associated with episiotomy in vacuum delivery: a systematic review and meta-analysis. BJOG 2015; 122:1073-81. [DOI: 10.1111/1471-0528.13439] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- L Sagi-Dain
- Department of Obstetrics and Gynaecology; Carmel Medical Centre; Haifa Israel
- Genetics Institute; HaEmek Medical Centre; Afula Israel
| | - S Sagi
- Department of Obstetrics and Gynaecology; Bnai Zion Medical Centre; Haifa Israel
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Saadia Z. Rates and Indicators for Episiotomy in Modern Obstetrics - a study from Saudi Arabia. Mater Sociomed 2014; 26:188-90. [PMID: 25126014 PMCID: PMC4130686 DOI: 10.5455/msm.2014.26.188-190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/25/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND This observational study aimed to describe the rates and indicators for practice of episiotomy during normal labour and to compare them between women who have had one pregnancy (PG) and women who have already delivered two or more children (G2 and above). METHODS The study was conducted at Mother and Child Hospital, Buraidah from October- December 2013 as a descriptive cross sectional study. RESULTS Overall rate of Episiotomy was 51.20%. Amongst the Primigravidas all went through episiotomies however in G2 and above only 7 patients (4.69%) delivered with episiotomy. Proportions tests revealed that there were significant differences between gravidity groups on two indications of episiotomy (vaginal breech p <0.001 and previous history of perineal tear p < 0.001). G2 and above had episiotomy for breech delivery (1 of 7 = 14.29%) significantly more often than PG participants (0 of 142 = 0.0%). And G2 and above participants experienced episiotomy for previous perineal tear (2 of 7 = 28.5% as compared to none in PG No other significant differences were found on indications of episiotomy. CONCLUSION Episiotomy is a very common obstetric intervention (51.20%). The PG experience episiotomy significantly more often than G2 and above women. Efforts should be made to reduce its rates. This can be done by reviewing the indications and rates at repeated intervals and setting guidelines for these indications.
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Affiliation(s)
- Zaheera Saadia
- Qassim University, College of medicine, Buraidah, Saudi Arabia ; Department of Obstetrics and Gynecology, Qassim College of Medicine, Buraidah, Saudi Arabia
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Thiagamoorthy G, Johnson A, Thakar R, Sultan AH. National survey of perineal trauma and its subsequent management in the United Kingdom. Int Urogynecol J 2014; 25:1621-7. [DOI: 10.1007/s00192-014-2406-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/13/2014] [Indexed: 11/30/2022]
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Le Ray C, Théau A, Ménard S, Goffinet F. [What is new about obstetrical interventions during labor and normal delivery?]. ACTA ACUST UNITED AC 2014; 43:413-23. [PMID: 24485806 DOI: 10.1016/j.jgyn.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
This systematic review of the literature reports studies published over the last five years (2008-2013) about interventions during labor and normal delivery. The points made concerning active management of labor, interventions aimed at improving maternal comfort, management of occiput posterior fetal presentations, management of second stage of labor and prevention techniques for perineal lesions. Although obstetrics remains an "art" to which training is mainly based on experience and clinical expertise, this "art" at present cannot live without the evidence-based medicine. Numerous randomized trials published and in process, demonstrate awareness of this reality in our specialty.
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Affiliation(s)
- C Le Ray
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France; Unité Inserm U953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, université Pierre-et-Marie-Curie, 53, avenue de l'Observatoire, 75014 Paris, France.
| | - A Théau
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France
| | - S Ménard
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France
| | - F Goffinet
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France; Unité Inserm U953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, université Pierre-et-Marie-Curie, 53, avenue de l'Observatoire, 75014 Paris, France
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Allary J, Soubirou JF, Michel J, Amiel I, Silins V, Brasher C, Oury JF, Nivoche Y, Dahmani S. An individual scoring system for the prediction of postpartum anaemia. ACTA ACUST UNITED AC 2013; 32:e1-7. [DOI: 10.1016/j.annfar.2012.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
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