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A novel classification for evaluating episiotomy practices: application to the Burgundy perinatal network
Thomas Desplanches1,2, Emilie Szczepanski3, Jonathan Cottenet4,5
1CHRU Dijon, Department of gynecology, obstetrics, fetal medicine and infertility, Dijon, France. thomas.desplanches@chu-dijon.fr.
A new classification system for episiotomy practices was developed, identifying subgroups where episiotomy reduces obstetric anal sphincter injuries (OASIS). This tool aids healthcare providers in refining delivery procedures and improving patient outcomes.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Care
- Surgical Procedures
Background:
- Episiotomy rates remain significant in France, despite a general decrease.
- A need exists for a standardized classification to analyze episiotomy practices and their impact on obstetric anal sphincter injuries (OASIS).
Purpose of the Study:
- To develop a classification system for episiotomy practices.
- To evaluate the association between episiotomy and OASIS rates within specific subgroups of deliveries.
Main Methods:
- A population-based study analyzed 81,290 deliveries from 2011-2016 in the Burgundy Perinatal Network.
- Ascending hierarchical cluster analysis created 7 distinct subgroups based on delivery characteristics.
- Episiotomy and OASIS rates were assessed for each subgroup, with statistical analysis of their association.
Main Results:
- The classification identified 7 subgroups, with episiotomy rates varying from 6.2% to 40.9%.
- OASIS prevalence was highest in nulliparous and multiparous instrumental delivery groups.
- Episiotomy use was linked to reduced OASIS rates in specific subgroups (nulliparous, nulliparous with instrumental delivery, and multiparous with forceps delivery).
Conclusions:
- The developed 7-subgroup classification provides a practical tool for evaluating episiotomy practices.
- This classification can assist obstetricians and midwives in self-assessment and improving clinical decision-making regarding episiotomy.
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