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Rousseau A, Dubel-Jam M, Schantz C, Gaucher L. Barrier measures implemented in French maternity hospitals during the COVID-19 pandemic: A cross-sectional survey. Midwifery 2023; 118:103600. [PMID: 36680960 PMCID: PMC9839455 DOI: 10.1016/j.midw.2023.103600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/12/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The objectives of this survey were 1) to describe the changes over time of barrier measures in maternity units, specifically, co-parent visits and women wearing masks in birth rooms, and 2) to identify potential institutional determinants of these barrier measures. DESIGN We used an online questionnaire to conduct a descriptive cross-sectional survey from May to July 2021. SETTING All districts in mainland France. PARTICIPANTS Midwife supervisor of each maternity unit. MEASUREMENTS Primary outcomes were "banning of visits" in the postnatal department during the first lockdown (March-May 2020), and "mandated mask-wearing in birth rooms" during the survey period (May-July 2021); the independent variables were maternity unit characteristics and location in a crisis area. Co-parent visits were considered only during the first lockdown as they were mostly allowed afterwards, and the wearing of masks was studied only during the survey period, as masks were unavailable for the population during the first lockdown. RESULTS We obtained 343 responses, i.e., 75.2% of French maternity units. Visits to the postnatal department were forbidden in 39.3% of the maternity units during the first lockdown and in none during the study period. Maternity hospitals with neonatal intensive care units were the most likely to ban co-parent hospital visits (adjusted OR 2.34 [1.12; 4.96]). However, those were the maternity units least likely to encourage or require women to wear masks while pushing (adjusted OR, 0.31; 95% confidence interval [CI], 0.11-0.77). Maternity units in crisis areas (i.e., with very high case counts) during the first lockdown banned visits significantly more often (adjusted OR, 1.68; 95% CI, 1.05-2.70). KEY CONCLUSIONS Our study showed that barrier measures evolved during the course of the pandemic but remained extremely variable between facilities. IMPLICATIONS FOR PRACTICE Maternity units implemented drastic barrier measures at the beginning of the pandemic but were able to adapt these measures over time. It is now time to learn from this experience to ensure that women and infants are no longer harmed by these measures.
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Affiliation(s)
- A. Rousseau
- Midwifery Department, EA 7285, Versailles Saint Quentin University, F-78180 Montigny-le-Bretonneux, France,Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, F-78300 Poissy, France,Université Paris-Saclay, UVSQ, Inserm, Équipe Epidémiologie clinique, CESP, 78180 Montigny le Bretonneux, France,Corresponding author at: UFR Simone Veil-Santé - 2 avenue de la Source de la Bièvre, F-78180 Montigny-le-Bretonneux, France
| | - M. Dubel-Jam
- Midwifery Department, EA 7285, Versailles Saint Quentin University, F-78180 Montigny-le-Bretonneux, France,Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, F-78300 Poissy, France
| | - C. Schantz
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - L. Gaucher
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Geneva, Switzerland,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, F-69008 Lyon, France,Hospices Civils de Lyon, Hôpital Femme Mère-Enfant, F-69500 Bron, France
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Sauvegrain P, Schantz C, Gaucher L, Chantry AA. Avenues for measuring and characterising violence in perinatal care to improve its prevention: A position paper with a proposal by the National College of French Midwives. Midwifery 2023; 116:103520. [PMID: 36384064 DOI: 10.1016/j.midw.2022.103520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND France is somewhat behind other countries in its consideration of the issue of violence in perinatal care. Its consequences on maternal, but also neonatal and infant health are recognised internationally. Nonetheless, research and data measuring its frequency and its determinants are inadequate, and the relevant definitions are not always consensual. In this context, we, as midwives and researchers in public health and as members of the National College of French Midwives, seek to propose a scientific and clinical contribution to this debate. AIM We propose avenues for measuring and characterising violence in perinatal care. Our objective is to quantify and characterise the situations of violence in perinatal care in population-based studies and based on the perceptions of each woman questioned. DISCUSSION This proposal for questions, simplified compared with those currently in used in the international scientific literature, has the advantage of focusing reflection around three categories: inappropriate medical care, inappropriate human behaviours in care, and sexual abuse. It should also allow the identification of the contexts of care during which violence may be experienced, as well as the categories of health-care workers concerned. CONCLUSION It seems important to us to distinguish these situations, causal and context, for they require different responses if we hope to reduce the frequency and the effects of violence in perinatal care in the future. We propose questions that could also be used in clinical situations by midwives and other clinicians.
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Affiliation(s)
- P Sauvegrain
- Midwifery School AP-HP- Sorbonne Université, F-75012 Paris, France; Université Paris Cité, Epidemiology and Statistics Research Center/CRESS/EPOPé Research Team, INSERM, INRA, F-75014 Paris, France.
| | - C Schantz
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France.
| | - L Gaucher
- Hospices Civils de Lyon, Hôpital Femme Mère-Enfant, F-69500 Bron, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Geneva, Switzerland.
| | - A A Chantry
- Université Paris Cité, Epidemiology and Statistics Research Center/CRESS/EPOPé Research Team, INSERM, INRA, F-75014 Paris, France; Midwifery School of Baudelocque, AP-HP, Université Paris Cité, F-75006 Paris, France.
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Petitprez K, Mattuizzi A, Guillaume S, Arnal M, Artzner F, Bernard C, Caron FM, Chevalier I, Daussy-Urvoy C, Ducloy-Bouthorsc AS, Garnier JM, Keita-Meyer H, Lavillonnière J, Lejeune-Sadaa V, Le Ray C, Morandeau A, Nadjafizade M, Pizzagalli F, Schantz C, Schmitz T, Shojai R, Hédon B, Sentilhes L. Normal delivery: physiologic support and medical interventions. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF). J Matern Fetal Neonatal Med 2021; 35:6576-6585. [PMID: 33980105 DOI: 10.1080/14767058.2021.1918089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To define for women at low obstetric risk methods of management that respect the rhythm and the spontaneous course of giving birth as well as each woman's preferences. METHODS These clinical practice guidelines were developed through professional consensus based on an analysis of the literature and of the French and international guidelines available on this topic. RESULTS Labor should be monitored with a partograph (professional consensus). Digital cervical examination should be offered every 4 h during the first stage of labor, hourly during the second. The choice between continuous (cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring should be left to the woman (professional consensus). In the active phase of the first stage of labor, dilation speed is considered abnormal if it is less than 1 cm/4 h between 5 and 7 cm or less than 1 cm/2 h after 7 cm. In those cases, an amniotomy is recommended if the membranes are intact, and the administration of oxytocin if the membranes are already broken and uterine contractions are judged insufficient (professional consensus). It is recommended that pushing not begin when full dilation has been reached; rather, the fetus should be allowed to descend (grade A). Umbilical cord clamping should be delayed beyond the first 30 s in newborns who do not require resuscitation (grade C). CONCLUSION The establishment of these clinical practice guidelines should enable women at low obstetric risk to receive better care in conditions of optimal safety while supporting physiologic birth.
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Affiliation(s)
- Karine Petitprez
- Department of good professional practices, Haute Autorité de Santé, Saint-Denis, France
| | - Aurélien Mattuizzi
- Department of Obstetrics and Gynecology, Maternité Aliénor d'Aquitaine, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Sophie Guillaume
- Department of Obstetrics and Gynecology, Hôpital Necker Enfants Malades, Assistance publique des hôpitaux de Paris, Paris, France
| | | | - France Artzner
- User representative, Collectif Inter-Associatif autour de la Naissance (CIANE), Montreuil, France
| | - Catherine Bernard
- User representative, Collectif Inter-Associatif autour de la Naissance (CIANE), Paris, France
| | - François-Marie Caron
- Pôle femme enfant Victor Pauchet, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | | | | | - Anne-Sophie Ducloy-Bouthorsc
- Department of anesthesia and critical care, Maternité Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | | | - Hawa Keita-Meyer
- Department of anesthesia and critical care, Hôpital Necker Enfants Malades, Assistance publique des hôpitaux de Paris, Paris, France
| | | | | | - Camille Le Ray
- Department of Obstetrics and Gynecology, Hôpital Cochin, Maternité Port Royal, Assistance publique des hôpitaux de Paris, Paris, France
| | | | - Marjan Nadjafizade
- School of Midwives, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Franck Pizzagalli
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Clamart, France
| | - Clemence Schantz
- CEPED, IRD, Université Paris Descartes, Inserm, équipe SAGESUD, Paris, France
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology, Hôpital Robert Debré, Assistance publique des hôpitaux de Paris, Paris, France
| | - Raha Shojai
- Department of Obstetrics and Gynecology, Clinique de l'étoile, Aix-en-Provence, France
| | - Bernard Hédon
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Maternité Aliénor d'Aquitaine, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Schantz C. [Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - Intrapartum care for healthy women and non pharmacological approaches for pain management]. Gynecol Obstet Fertil Senol 2020; 48:883-890. [PMID: 33011379 DOI: 10.1016/j.gofs.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To make clinical practice guidelines for intrapartum care for healthy women and non-pharmacologic approaches for pain management. METHODS Review of the literature of articles published between January 2000 and September 2017 in English and French language from the Medline database, the Cochrane Library and recommendations from international institutes. RESULTS During the initial examination of a pregnant woman, it is recommended to take note of the pregnancy monitoring file and its possible birth plan; perform an anamnesis, inquire about her wishes and physiological and emotional needs; and perform a clinical examination (Consensus agreement). If the woman seems to be in labor, it is recommended to offer a vaginal examination (Consensus agreement). In case of premature rupture of membranes, it is recommended not to systematically perform a vaginal examination if the woman has no painful contractions (Consensus agreement). During the first stage of labor, the surveillance of the woman includes at least: a surveillance of the haemodynamic parameters every four hours; an evaluation of the frequency of uterine contractions every 30minutes and for 10minutes during the active phase; surveillance of spontaneous urination; the proposition of a vaginal examination every two to four hours or before if the patient asks for it, or in case of sign of call (Consensus agreement). During the second stage, it is recommended to use a partograph; to monitor hemodynamic parameters every hour; to evaluate the frequency of uterine contractions every 30minutes and for ten minutes; to monitor and note spontaneous urination; to offer a vaginal examination every hour (Consensus agreement). Whether on admission or during labor, it is recommended to evaluate the pain and offer the patient different ways to relieve it (Consensus agreement). It is recommended that all women have continuous, individual and personalized support, during labor and delivery (grade A); to implement the necessary human and material resources allowing women to change position regularly (Consensus agreement). CONCLUSION Routine practices must be abandoned to implement those that are scientifically justified. The management of pain is essential. Every woman should have continuous, individual and personalized support during labor and delivery.
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Affiliation(s)
- C Schantz
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université de Paris, Inserm ERL 1244, Paris, France.
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Petitprez K, Guillaume S, Mattuizzi A, Arnal M, Artzner F, Bernard C, Bonnin M, Bouvet L, Caron FM, Chevalier I, Daussy-Urvoy C, Ducloy-Bouthorsc AS, Garnier JM, Keita-Meyer H, Lavillonnière J, Lejeune-Sadaa V, Leray C, Morandeau A, Morau E, Nadjafizade M, Pizzagalli F, Schantz C, Schmitz T, Shojai R, Hédon B, Sentilhes L. [Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) -- Text of the Guidelines (short text)]. Gynecol Obstet Fertil Senol 2020; 48:873-882. [PMID: 33011381 DOI: 10.1016/j.gofs.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of these guidelines is to define for women at low obstetric risk modalities that respect the physiology of delivery and guarantee the quality and safety of maternal and newborn care. METHODS These guidelines were made by a consensus of experts based on an analysis of the scientific literature and the French and international recommendations available on the subject. RESULTS It is recommended to conduct a complete initial examination of the woman in labor at admission (consensus agreement). The labor will be monitored using a partogram that is a useful traceability tool (consensus agreement). A transvaginal examination may be offered every two to four hours during the first stage of labor and every hour during the second stage of labor or before if the patient requests it, or in case of a warning sign. It is recommended that if anesthesia is required, epidural or spinal anesthesia should be used to prevent bronchial inhalation (grade A). The consumption of clear fluids is permitted throughout labor in patients with a low risk of general anesthesia (grade B). It is recommended to carry out a "low dose" epidural analgesia that respects the experience of delivery (grade A). It is recommended to maintain the epidural analgesia through a woman's self-administration pump (grade A). It is recommended to give the woman the choice of continuous (by cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring if the conditions of maternity organization and the permanent availability of staff allow it and, after having informed the woman of the benefits and risks of each technique (consensus agreement). In the active phase of the first stage of labor, the dilation rate is considered abnormal if it is less than 1cm/4h between 5 and 7cm or less than 1cm/2h above 7cm (level of Evidence 2). It is then recommended to propose an amniotomy if the membranes are intact or an oxytocin administration if the membranes are already ruptured, and the uterine contractions considered insufficient (consensus agreement). It is recommended not to start expulsive efforts as soon as complete dilation is identified, but to let the presentation of the fetus drop (grade A). It is recommended to inform the gynecologist-obstetrician in case of nonprogression of the fetus after two hours of complete dilation with sufficient uterine dynamics (consensus agreement). It is recommended not to use abdominal expression (grade B). It is recommended to carry out preventive administration of oxytocin at 5 or 10 IU to prevent PPH after vaginal delivery (grade A). In the case of placental retention, it is recommended to perform a manual removal of the placenta (grade A). In the absence of bleeding, it should be performed 30minutes but not more than 60minutes after delivery (consensus agreement). It is recommended to assess at birth the breathing or screaming, and tone of the newborn to quickly determine if resuscitation is required (consensus agreement). If the parameters are satisfactory (breathing present, screaming frankly, and normal tonicity), it is recommended to propose to the mother that she immediately place the newborn skin-to-skin with her mother if she wishes, with a monitoring protocol (grade B). Delayed cord clamping is recommended beyond the first 30seconds in neonates, not requiring resuscitation (grade C). It is recommended that the first oral dose (2mg) of vitamin K (consensus agreement) be given systematically within two hours of birth. CONCLUSION These guidelines allow women at low obstetric risk to benefit from a better quality of care and optimal safety conditions while respecting the physiology of delivery.
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Affiliation(s)
- K Petitprez
- Service des bonnes pratiques professionnelles, Haute Autorité de santé, 93218 Saint-Denis, France
| | - S Guillaume
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | - A Mattuizzi
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | | | - F Artzner
- Collectif inter-associatif autour de la naissance (CIANE), 93100 Montreuil, France
| | - C Bernard
- Collectif inter-associatif autour de la naissance (CIANE), 75011 Paris, France
| | - M Bonnin
- Service d'anesthésie-réanimation, hôpital d'Estaing, centre hospitalier universitaire de Clermont-Ferrand, 63100 Clermont-Ferrand, France
| | - L Bouvet
- Service d'anesthésie-réanimation, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69000 Lyon, France
| | - F-M Caron
- Pôle femme enfant Victor-Pauchet, centre hospitalier universitaire d'Amiens, 80080 Amiens, France
| | | | | | - A-S Ducloy-Bouthorsc
- Service d'anesthésie-réanimation, maternité Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 59000 Lille, France
| | | | - H Keita-Meyer
- Service d'anesthésie-réanimation, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | | | - V Lejeune-Sadaa
- Service de gynécologie-obstétrique, centre hospitalier d'Auch, 32008 Auch, France
| | - C Leray
- Service de gynécologie-obstétrique, hôpital Cochin, maternité Port-Royal, Assistance publique des Hôpitaux de Paris, 75014 Paris, France
| | | | - E Morau
- Service d'anesthésie-réanimation, centre hospitalier de Narbonne, 11100 Narbonne, France
| | - M Nadjafizade
- École de sages-femmes, centre hospitalier régional universitaire de Nancy, 54035 Nancy, France
| | - F Pizzagalli
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, 92140 Clamart, France
| | - C Schantz
- CEPED, IRD, université Paris Descartes, Inserm, équipe SAGESUD, 75006 Paris, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 75019 Paris, France
| | - R Shojai
- Service de gynécologie-obstétrique, clinique de l'étoile, 13100 Aix-en-Provence, France
| | - B Hédon
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Montpellier, 34295 Montpellier, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
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Ducarme G, Pizzoferrato A, de Tayrac R, Schantz C, Thubert T, Le Ray C, Riethmuller D, Verspyck E, Gachon B, Pierre F, Artzner F, Jacquetin B, Fritel X. Perineal prevention and protection in obstetrics: CNGOF clinical practice guidelines. J Gynecol Obstet Hum Reprod 2019; 48:455-460. [DOI: 10.1016/j.jogoh.2018.12.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/10/2018] [Indexed: 11/16/2022]
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de Tayrac R, Schantz C. [Childbirth pelvic floor trauma: Anatomy, physiology, pathophysiology and special situations - CNGOF perineal prevention and protection in obstetrics guidelines]. ACTA ACUST UNITED AC 2018; 46:900-912. [PMID: 30396762 DOI: 10.1016/j.gofs.2018.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess whether pelvic size and shape, spinal curvature, perineal body length and genital hiatus size are associated with the incidence of childbirth pelvic floor trauma. Special situations, such as obesity, ethnicity and hyperlaxity, will also be studied. METHODS A bibliographic research using Pubmed and Cochrane Library databases was conducted until May 2018. Publications in English and French were selected by initial reading of the abstracts. Randomized trials, meta-analyzes, case-control studies and large cohorts were studied in a privileged way. RESULTS A pubic arch angle<90° (measured clinically) does not appear to increase the risk of OASIS (Level 3), but appears to be a risk factor for postnatal anal incontinence at short-term, but not at long-term (Level 3). Measurement of pelvic dimensions and the subpubic angle is not recommended to predict OASIS or to choose the mode of delivery for the purpose of protecting the perineum (GradeC). Prenatal measurement of both perineal body (Level 3) and genital hiatus (Level 2) does not predict the incidence of 2nd or 3rd degree OASIS. Therefore, the routine prenatal measurement of the length of the perineal body or the genital hiatus is not recommended for any objective related to perineal protection (Grade C). Levator avulsion, resulting in a widening of the genital hiatus, is potentially a source of long-term pelvic floor dysfunction. Biomechanical models suggest that performing a mediolateral episiotomy and applying the fingers to the posterior perineum at the time of expulsive phase may reduce pelvic floor trauma. Obese women have a longer perineal body (Level 3), and obesity does not seem to increase the risk of OASIS (Level 2). There is no difference between Asian and non-Asian women perineal body (Level 3). No studies have validated that the liberal practice of episiotomy in Asian women reduced the risk of OASIS. It is therefore not recommended to practice an episiotomy for simple ethnic reasons in Asian women (GradeC). Compared to white women, black women do not appear to have an increased risk of OASIS and even appear to have a decreased risk of perineal tears of all stages (Level 2). Ligament hyperlaxity seems to be associated with an increased risk of OASIS (Level 2). CONCLUSIONS Prenatal assessment of pelvis bone, spine curvature, perineal body and genital hiatus do not allow to predict the incidence of childbirth pelvic floor trauma. Obesity and ethnicity are not risk factors for OASIS.
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Affiliation(s)
- R de Tayrac
- Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Debré, 30900 Nîmes, France.
| | - C Schantz
- Commission Scientifique du Collège National des Sages-Femmes (CNSF), Centre population et développement (Ceped), institut de la recherche et du développement (IRD), université Paris Descartes, Inserm, 75006, Paris, France
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Schantz C. [Methods of preventing perineal injury and dysfunction during pregnancy: CNGOF Perineal prevention and protection in obstetrics]. ACTA ACUST UNITED AC 2018; 46:922-927. [PMID: 30392987 DOI: 10.1016/j.gofs.2018.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Several interventions during pregnancy have been described that might prevent the risk of postnatal perineal injury or dysfunction; these include prenatal perineal massage, use of the Epi-No device, and pelvic floor muscle training exercises. Our objective was to evaluate the effectiveness of these different interventions during pregnancy. METHODS A systematic review of the literature was conducted on PubMed, including articles in French and English published before May 2018, to evaluate the effectiveness of these different interventions on perineal protection in the post-partum period. RESULTS Perineal massage during pregnancy diminishes the episiotomy rate (LE1) as well as post-partum perineal pain and flatus (LE2). It does not reduce the rate of either OASIS (LE1) or post-partum urinary incontinence (LE2). The Epi-No device does not provide benefits for perineal protection (LE1). Prenatal pelvic floor muscle training exercises do not reduce the risk of perineal lacerations (LE2); they reduce the prevalence of post-partum urinary incontinence at 3 to 6 months but not at 12 months post-partum (LE2). CONCLUSION Perineal massage during pregnancy must be encouraged among women who want it (Grade B). The use of the Epi-No device during pregnancy is not recommended for the prevention of OASIS (grade B). Pelvic floor muscle training during pregnancy is not recommended for the prevention of OASIS (grade B); moreover, its absence of effect in the medium term does not allow us to recommend it for urinary incontinence (professional consensus).
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Affiliation(s)
- C Schantz
- Commission scientifique du Collège National des sages-femmes (CNSF), Centre population et développement (Ceped), institut de la recherche et du développement (IRD), université Paris Descartes, Inserm, 45, rue des Saints-Pères, 75006 Paris, France.
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Ducarme G, Pizzoferrato AC, de Tayrac R, Schantz C, Thubert T, Le Ray C, Riethmuller D, Verspyck E, Gachon B, Pierre F, Artzner F, Jacquetin B, Fritel X. [Perineal prevention and protection in obstetrics: CNGOF Clinical Practice Guidelines (short version)]. ACTA ACUST UNITED AC 2018; 46:893-899. [PMID: 30391283 DOI: 10.1016/j.gofs.2018.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter injuries (OASIS) and postnatal pelvic floor symptoms. MATERIAL AND METHODS These guidelines were developed in accordance with the methods prescribed by the French Health Authority (HAS). RESULTS A prenatal clinical examination of the perineum is recommended for women with a history of Crohn's disease, OASIS, genital mutilation, or perianal lesions (professional consensus). Just after delivery, a perineal examination is recommended to check for OASIS (Grade B); if there is doubt about the diagnosis, a second opinion should be requested (GradeC). In case of OASIS, the injuries (including their severity) and the technique for their repair should be described in detail (GradeC). Perineal massage during pregnancy must be encouraged among women who want it (Grade B). No intervention conducted before the start of the active phase of the second stage of labour has been shown to be effective in reducing the risk of perineal injury. The crowning of the baby's head should be manually controlled and the posterior perineum manually supported to reduce the risk of OASIS (GradeC). The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). In instrumental deliveries, episiotomy may be indicated to avoid OASIS (GradeC). When an episiotomy is performed, a mediolateral incision is recommended (Grade B). The indication for episiotomy should be explained to the woman, and she should consent before its performance. Advising women to have a caesarean delivery for primary prevention of postnatal urinary or anal incontinence is not recommended (Grade B). During pregnancy and again in the labour room, obstetrics professionals should focus on the woman's expectations and inform her about the modes of delivery.
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Affiliation(s)
- G Ducarme
- Service de gynécologie-obstétrique, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France.
| | - A C Pizzoferrato
- Service de gynécologie-obstétrique, CHU Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - R de Tayrac
- Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Debré, 30900 Nîmes, France
| | - C Schantz
- Centre population et développement (Ceped), institut de la recherche et du développement (IRD), université Paris Descartes, Inserm, Commission scientifique du Collège national des sages-femmes (CNSF), 75000 Paris, France
| | - T Thubert
- Service de gynécologie-obstétrique, CHU Hôtel-Dieu, hôpitaux de Nantes, université de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; GMC-UPMC 01, GREEN (Groupe de recherche clinique en neurourologie), 4, rue de la Chine, 75020 Paris, France
| | - C Le Ray
- Maternité Port-Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 123, boulevard de Port-Royal, 75014 Paris, France; Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - D Riethmuller
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - E Verspyck
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - B Gachon
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - F Pierre
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - F Artzner
- Collectif inter-associatif autour de la naissance (CIANE), 40, rue de Chanzy, 75011 Paris, France
| | - B Jacquetin
- Pôle Femme-Enfant, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Schantz C. The trouble with clinical trials. Internist 1979; 20:9-10. [PMID: 10243880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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