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Published on: January 17, 2019
[Impact of a major decrease in the use of episiotomy on perineal tears in a level III maternity ward]
M Chehab1, M Courjon1, A Eckman-Lacroix1
1Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Flemming, 25030 Besançon cedex, France.
Objective:
To evaluate the perineal outcome after a major decrease in episiotomy rate in a high-risk (level III) maternity ward.
Materials And Methods:
This was a retrospective cohort study in a teaching high-risk maternity comparing perineal tears between 2003 and 2010. We included for analysis: pregnancies at 25 weeks or more, fetal birthweights of 500 g or more, vaginal deliveries in our maternity, singletons or multiple pregnancies, cephalic or breech presentations.
Results:
The two populations were comparable. In 2003, we performed 18.8% of episiotomies and 1.3% in 2010. Between these years, our intact perineum rate increased from 28.8 to 37.5% (P<0.0001). We also report an increase in first and second degree perineum lesions (20.5% in 2003 and 40.2% in 2010, P<0.0001) and anterior perineal lesions (17.8% in 2003 and 30.3% in 2010, P<0.0001). We also report a significant decrease in perineal lesions with sphincter injuries (1% in 2003 and 0.3% in 2010 P<0.0001).
Discussion:
Comparing 2003 to 2010, the majority of cases with no episiotomy (over 2/3) resulted in first degree perineum lesions which are today recognized as benign lesions without any systematic need for suturing. A restrictive use of episiotomy increases the rate of intact perineum and of "non-severe" perineal lesions.
