[Impact of a major decrease in the use of episiotomy on perineal tears in a level III maternity ward]

Area of Science:

• Obstetrics and Gynecology
• Perineal Health
• Surgical Intervention Outcomes

Background:

• Episiotomy is a surgical procedure performed during childbirth.
• Historically, episiotomy rates have varied significantly, with high-risk maternity wards often employing higher rates.
• The impact of reducing episiotomy rates on perineal outcomes requires ongoing evaluation.

Purpose of the Study:

• To assess the perineal outcomes in a high-risk maternity ward following a substantial reduction in episiotomy rates.
• To compare perineal tear incidence and severity before and after the implementation of a restrictive episiotomy policy.

Main Methods:

• Retrospective cohort study design comparing two periods (2003 and 2010).
• Inclusion criteria: pregnancies ≥25 weeks, fetal birthweight ≥500g, vaginal deliveries, singleton or multiple gestations, cephalic or breech presentations.
• Analysis focused on perineal tear rates, including intact perineum, degrees of perineal lesions, and sphincter injuries.

Main Results:

• Episiotomy rates decreased from 18.8% in 2003 to 1.3% in 2010.
• The rate of intact perineums increased significantly from 28.8% to 37.5% (P<0.0001).
• There was a significant increase in first and second-degree perineal lesions, alongside a decrease in severe perineal lesions with sphincter injuries (P<0.0001).

Conclusions:

• A restrictive episiotomy approach is associated with an increased rate of intact perineums.
• The majority of non-episiotomy cases result in first-degree perineal tears, often considered benign.
• Reducing episiotomies can lead to improved perineal outcomes, with fewer severe injuries.