[Influence of a major decrease in the use of episiotomy applied to a high risk perineal situation: Occiput posterior...

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Outcomes

Background:

• Occiput-posterior (OP) presentation occurs in 5% of deliveries and is associated with increased risk of perineal tears.
• Episiotomy is sometimes recommended in OP presentations to prevent severe perineal trauma.

Purpose of the Study:

• To assess the impact of an ultra-restrictive episiotomy policy on perineal tears in occiput-posterior deliveries.
• To compare perineal outcomes between occiput-posterior and occiput-anterior presentations under a restrictive episiotomy strategy.

Main Methods:

• Retrospective cohort study comparing occiput-posterior (OP) and occiput-anterior (OA) deliveries.
• Included live, singleton pregnancies delivered after 37 weeks gestation between January 2008 and December 2012.
• Analyzed spontaneous and assisted deliveries, comparing perineal outcomes, episiotomy rates, and postpartum hemorrhage.

Main Results:

• Similar episiotomy rates were observed between OP (1.3%) and OA (1.8%) groups (p=0.5).
• The OP group experienced a higher incidence of second-degree perineal tears (p<0.001), but rates of severe perineal tears were comparable.
• No significant increase in postpartum hemorrhage was noted; however, neonatal outcomes were less favorable in the OP group.

Conclusions:

• A restrictive episiotomy strategy in occiput-posterior deliveries does not elevate the risk of severe perineal tears.
• This policy appears safe regarding severe perineal outcomes and does not worsen the overall perineal prognosis in OP presentations.