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Forey PL, Soulier C, Curtelin C, Curto L, Préaubert L, Hoffmann P, Riethmuller D. [Introduction of the Couder manoeuvre and perineal injuries]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:645-649. [PMID: 34896636 DOI: 10.1016/j.gofs.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyse the introduction of the Couder manoeuvre in our level 3 maternity unit shortly after its introduction in 2019. Then, to evaluate and compare the rate of perineal injuries between 2017, when the manoeuvre was not performed at all, and 2020. MATERIALS AND METHOD A single-centre retrospective study of patients who delivered a singleton eutociously at term from 1 January to 31 December 2017 and 2020. RESULTS In total, 2930 records were analysed. The Couder manoeuvre rate was 32.12% in 2020. A change in the distribution of perineal lesions was observed: the rate of intact perineum increased (P<0.001), while 2nd degree lesions decreased between 2017 and 2020 (P<0.05). The 1st degree perineum and obstetric anal sphincter injuries remained stable. The rate of episiotomy decreased significantly by almost a factor of 7. CONCLUSION The practice of the Couder manoeuvre can be implemented fairly quickly after training of the actors with nearly a third of normal deliveries at term concerned one year after its introduction. This manoeuvre seems, in our practice, to have contributed to the reduction, as previously reported, of the rate of second degree perineal injuries.
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Affiliation(s)
- P-L Forey
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU d'Alpes-Grenoble, Grenoble, France
| | - C Soulier
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU d'Alpes-Grenoble, Grenoble, France
| | - C Curtelin
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU d'Alpes-Grenoble, Grenoble, France
| | - L Curto
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU d'Alpes-Grenoble, Grenoble, France
| | - L Préaubert
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU d'Alpes-Grenoble, Grenoble, France
| | - P Hoffmann
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU d'Alpes-Grenoble, Grenoble, France
| | - D Riethmuller
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU d'Alpes-Grenoble, Grenoble, France.
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Lebraud M, Loussert L, Griffier R, Gauthier T, Parant O, Guerby P. Maternal and neonatal morbidity after forceps or spatulas-assisted delivery in preterm birth. Eur J Obstet Gynecol Reprod Biol 2022; 271:128-131. [PMID: 35183002 DOI: 10.1016/j.ejogrb.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/04/2022] [Accepted: 02/11/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to assess perinatal morbidity associated with spatulas or forceps assisted delivery in preterm birth. STUDY DESIGN This is a retrospective cohort study including all women with assisted deliveries on singleton pregnancy in cephalic presentation, before 37 weeks of gestation, in two tertiary care centers. We compared forceps-assisted deliveries with spatula-assisted deliveries. The main outcome was the rate of neonatal birth trauma. Secondary outcomes included other neonatal parameters, maternal outcomes and obstetric anal sphincter injuries. RESULTS Out of 37 002 deliveries, 59 (0.2 %) preterm assisted deliveries with forceps and 111 (0.3%) preterm spatulas deliveries were included. The rate of neonatal birth trauma was low for both devices, without significant difference (3.4% in Forceps group vs 0.9% in Spatulas group, p = 0.28). The rate of episiotomy was 79.7% after forceps-assisted delivery and 48.6% for spatulas (p < 0.001). The rate of obstetric anal sphincter injuries was 1.7% and 2.7% respectively (p = 0,9). CONCLUSION The rate of birth trauma was low in both forceps-assisted deliveries and spatula-assisted deliveries and was not significantly different between the two groups.
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Affiliation(s)
- Margaux Lebraud
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne, TSA 70034 31059 Toulouse, France
| | - Lola Loussert
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne, TSA 70034 31059 Toulouse, France
| | - Romain Griffier
- Department of Public Health, CHU Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France
| | - Tristan Gauthier
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne, TSA 70034 31059 Toulouse, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne, TSA 70034 31059 Toulouse, France; Toulouse Institute for Infectious and Inflammatory Diseases, Inserm UMR 1291 - CNRS UMR 5051 - University Toulouse III, France.
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Morgan R, Korb D, Sibony O. Classification and evaluation of episiotomy practices from 2004 to 2020 and association with OASIS. Int J Gynaecol Obstet 2022; 159:237-245. [PMID: 34995361 DOI: 10.1002/ijgo.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/16/2021] [Accepted: 01/06/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To apply a new classification based on 7 clinically relevant subgroups to accurately describe episiotomy practices and evaluate the association between episiotomy and obstetrical anal sphincter injuries (OASIS) rates according to the classification's subgroups. METHODS Observational retrospective cohort study based on a population comprising 39487 women from 01/01/2004 to 31/12/2020 in a level III university maternity unit. The primary outcome was the overall episiotomy rate in the institution, its trend over the time as well as in each subgroup of obstetric population classification. Secondary outcome was the rate of OASIS third and fourth degree, its association with episiotomy practice. RESULTS The episiotomy rate decreased significantly from 43,2% to 20% in the total population. The overall OASIS rate was 0,34%, it remained significantly the same during the study period, although the association between OASIS and episiotomy was significant only in group 2 (Nulliparous with instrumental delivery) with a decrease of OASIS rate if using episiotomy (OR 0.5; 95% CI[0,3-0,8]). CONCLUSION The episiotomy rate can be decreased without exposing women to an increased risk of OASIS. It encourages restrictive practice of episiotomy, but episiotomy should be considered in case of nulliparous women with instrumental delivery.
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Affiliation(s)
- Rosemary Morgan
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
| | - Diane Korb
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France.,University of Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Olivier Sibony
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
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Blanc-Petitjean P, Saumier S, Meunier G, Sibiude J, Mandelbrot L. Prolongation of active second stage of labor: Associated factors and perinatal outcomes. J Gynecol Obstet Hum Reprod 2021; 50:102205. [PMID: 34391951 DOI: 10.1016/j.jogoh.2021.102205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/09/2021] [Accepted: 08/09/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Current data does not allow to define a reasonable threshold of duration of active second stage (ASS) of labor beyond which a medical intervention should be considered. Primary objective was to analyse perinatal outcomes associated with prolonged ASS beyond 45 min. Secondarily, we analysed associated maternal, gestational, labor and delivery characteristics associated with prolonged ASS. METHODS We performed a monocentric retrospective study among women with vaginal delivery, a term singleton cephalic fetus, without history of cesarean section. We compared women with active second stage of labor longer than 45 min (ASS ≥45 min, group A) and women with instrumental vaginal delivery (IVD) only for failure to progress (FtP) before 45 min of pushing (group B). Primary outcome was postpartum hemorrhage (PPH). Maternal and neonatal outcomes associated with ASS ≥ 45 min were assessed with multivariable logistic regression models. RESULTS Prolonged ASS ≥45 min (group A, N=177) was associated with lower rate of persistent occiput posterior position (1.7 vs 9.5%, p<0.01) and of non-engaged presentation when expulsive efforts started (10.7 vs 27.4%, p<0.01), compared to IVD for FtP <45 min (group B, N=84). In group A, 52% of women had instrumental delivery. Prolonged active second stage was independently associated with lower odds of episiotomy (38.4 vs 61.9%, AOR(95%CI)=0.43[0.24-0.78]) and was not associated with PPH (5.1 vs 5.9%, AOR=1.01[0.28-3.68]), pH<7.20, 5-min Apgar score < 7 (20.2 vs 15.9%, AOR=2.00[0.89-4.48]), lactates > 6 (23.0 vs 24.3, AOR=1.45[0.68-3.07]) or transfer to neonatal intensive care unit (6.2 vs 2.4%, AOR=4.71[0.76-29.08]. DISCUSSION Extending the duration of active second stage of labor beyond 45 min seems reasonable under rigorous surveillance of maternal and fetal wellbeing.
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Affiliation(s)
- Pauline Blanc-Petitjean
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France; AP-HP, Louis Mourier Hospital, Department of Obstetrics and Gynecology, Université de Paris, F-92700, Colombes, France.
| | - Solenne Saumier
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France; Université de Paris, Baudelocque Midwifery school, F-75014, Paris, France
| | | | - Jeanne Sibiude
- AP-HP, Louis Mourier Hospital, Department of Obstetrics and Gynecology, Université de Paris, F-92700, Colombes, France; Université de Paris, IAME, INSERM, F-75018 Paris, France
| | - Laurent Mandelbrot
- AP-HP, Louis Mourier Hospital, Department of Obstetrics and Gynecology, Université de Paris, F-92700, Colombes, France; Université de Paris, IAME, INSERM, F-75018 Paris, France
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Lebraud M, Griffier R, Hmila S, Aubard Y, Gauthier T, Parant O, Guerby P. Comparison of maternal and neonatal outcomes after forceps or spatulas-assisted delivery. Eur J Obstet Gynecol Reprod Biol 2020; 258:126-131. [PMID: 33421809 DOI: 10.1016/j.ejogrb.2020.12.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to compare the perinatal outcomes associated with spatulas or forceps assisted delivery. STUDY DESIGN This is a bicentric retrospective cohort study including all assisted deliveries in cephalic presentation after 37 weeks of gestation, performed on singleton pregnancy with forceps and with spatulas in two tertiary centers. The main outcome was the rate of episiotomy. Secondary outcomes included obstetric anal sphincter injuries (OASIS), maternal outcomes and neonatal parameters. RESULTS Out of 37 002 deliveries, the overall rate of assisted delivery was 11.4 %, and 1 041 (2.8 %) assisted deliveries with forceps and 2 462 (6.7 %) spatulas deliveries were included. The rate of episiotomy was 90.3 % after forceps-assisted delivery and 70.9 % for spatulas (p < 0.001). The rate of OASIS was 7.2 % and 5.6 % respectively (p = 0.06). A slight but significant decrease in neonatal trauma after spatulas was observed. CONCLUSION In this retrospective cohort study, the episiotomy rate was higher with forceps assisted deliveries than with spatulas. Both instruments have low neonatal morbidity and are similar regarding OASIS.
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Affiliation(s)
- Margaux Lebraud
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France
| | - Romain Griffier
- Department of Public Health, CHU Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France
| | - Salwa Hmila
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Yves Aubard
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Tristan Gauthier
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France; Université Paul-Sabatier Toulouse III, 31330 Toulouse, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France; Université Paul-Sabatier Toulouse III, 31330 Toulouse, France.
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Coste Mazeau P, Boukeffa N, Ticaud Boileau N, Huet S, Traverse M, Eyraud JL, Laguerre A, Catalan C, Riedl C. Evaluation of Suzor forceps training by studying obstetric anal sphincter injuries: a retrospective study. BMC Pregnancy Childbirth 2020; 20:674. [PMID: 33167939 PMCID: PMC7653800 DOI: 10.1186/s12884-020-03358-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Instrumental deliveries are an unavoidable part of obstetric practice. Dedicated training is needed for each instrument. To identify when a trainee resident can be entrusted with instrumental deliveries by Suzor forceps by studying obstetric anal sphincter injuries. METHODS A French retrospective observational study of obstetric anal sphincter injuries due to Suzor forceps deliveries performed by trainee residents was conducted from November 2008 to November 2016 at Limoges University Hospital. Perineal lesion risk factors were studied. Sequential use of a vacuum extractor and then forceps was also analyzed. RESULTS Twenty-one residents performed 1530 instrumental deliveries, which included 1164 (76.1%) using forceps and 89 (5.8%) with sequential use of a vacuum extractor and then forceps. Third and fourth degree perineal tears were diagnosed in 82 patients (6.5%). Residents caused fewer obstetric anal sphincter injuries after 23.82 (+/- 0.8) deliveries by forceps (p = 0.0041), or after 2.36 (+/- 0.7) semesters of obstetrical experience (p = 0.0007). No obese patient (body mass index> 30) presented obstetric anal sphincter injuries (p = 0.0013). There were significantly fewer obstetric anal sphincter injuries after performance of episiotomy (p < 0.0001), and more lesions in the case of the occipito-sacral position (p = 0.028). Analysis of sequential instrumentation did not find any additional associated risk. CONCLUSION Training in the use of Suzor forceps requires extended mentoring in order to reduce obstetric anal sphincter injuries. A stable level of competence was found after the execution of at least 24 forceps deliveries or after 3 semesters (18 months) of obstetrical experience.
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Affiliation(s)
- Perrine Coste Mazeau
- Department of Gynecology and Obstetrics, Mother and Child Hospital, Limoges Regional University Hospital, 8 avenue Dominique Larrey, 87000, Limoges, France.
| | - Nedjma Boukeffa
- Department of Gynecology and Obstetrics, Mother and Child Hospital, Limoges Regional University Hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Nathalie Ticaud Boileau
- Department of Gynecology and Obstetrics, Mother and Child Hospital, Limoges Regional University Hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Samantha Huet
- Department of Gynecology and Obstetrics, Mother and Child Hospital, Limoges Regional University Hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Maud Traverse
- Department of Gynecology and Obstetrics, Mother and Child Hospital, Limoges Regional University Hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Jean-Luc Eyraud
- Department of Gynecology and Obstetrics, Mother and Child Hospital, Limoges Regional University Hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Alexine Laguerre
- Department of Gynecology and Obstetrics, Mother and Child Hospital, Limoges Regional University Hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Cyrille Catalan
- Department of Gynecology and Obstetrics, Mother and Child Hospital, Limoges Regional University Hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Cécilia Riedl
- Department of Gynecology and Obstetrics, Mont-de-Marsan Hospital Center, 417 Avenue Pierre de Coubertin, 40024, Mont-de-Marsan, France
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Blanc-Petitjean P, Meunier G, Sibiude J, Mandelbrot L. Evaluation of a policy of restrictive episiotomy on the incidence of perineal tears among women with spontaneous vaginal delivery: A ten-year retrospective study. J Gynecol Obstet Hum Reprod 2020; 49:101870. [PMID: 32673815 DOI: 10.1016/j.jogoh.2020.101870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Routine episiotomy is no longer recommended to limit obstetrical anal sphincter injuries (OASIs). We aimed to evaluate the effect of a restrictive policy of episiotomy on the risk of OASIs during spontaneous vaginal deliveries. MATERIAL AND METHODS We performed a retrospective single-center observational study among women with a term singleton cephalic fetus, with spontaneous vaginal delivery. The occurrence of episiotomy, intact perineum, first, second, third or fourth-degree (OASIs) perineal tears were compared before (period A, from 01/01/2006 to 12/31/2008) and after (period B, from 01/01/2012 to 12/31/2016) implementation of the restrictive policy. Odds of perineal tear were estimated using multivariable logistic regression models, stratified by parity. RESULTS From 2006-2016, the rate of episiotomy decreased, from 14.9 % (n/N=200/1141) to 4.7 % (94/1912). In period B (N=8984) vs A (N=8984), the rates of episiotomy were, 12.9 vs 26.6 % for nulliparas (p<0.01) and 2.3 vs 6.8 % for multiparas (p<0.01). Odds of OASIs were not different in period B vs A, both for nulliparas (0.9 vs 0.8 %, AOR=0.88(0.38-2.05)) and multiparas (0.4 vs 0.2 %, AOR=2.28(0.63-8.29). Odds of second-degree tear were higher in period B vs A, both for nulliparas (39.8 vs 17.4 %, AOR=2.55(2.11-3.08) and multiparas (26.2 vs 12.8 %, AOR=2.26(1.95-2.66)); and odds of intact perineum were lower (for nulliparas, 15.8 vs 24.9 %, AOR=0.61(0.42-0.90) and for multiparas, 47.1 vs 56.0 %, AOR=0.61(0.49-0.76)). No difference was observed for first-degree tears. CONCLUSION The progressive implementation of a restrictive policy of episiotomy during spontaneous vaginal delivery was not associated with an increased risk of OASIs over a ten-year period.
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Affiliation(s)
- Pauline Blanc-Petitjean
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France; AP-HP, Louis Mourier Hospital, Department of Obstetrics and Gynecology, FHU PREMA, F-92700, Colombes, France.
| | - Géraldine Meunier
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France; AP-HP, Louis Mourier Hospital, Department of Obstetrics and Gynecology, FHU PREMA, F-92700, Colombes, France
| | - Jeanne Sibiude
- AP-HP, Louis Mourier Hospital, Department of Obstetrics and Gynecology, FHU PREMA, F-92700, Colombes, France; Université de Paris, IAME, INSERM, F-75018 Paris, France
| | - Laurent Mandelbrot
- AP-HP, Louis Mourier Hospital, Department of Obstetrics and Gynecology, FHU PREMA, F-92700, Colombes, France; Université de Paris, IAME, INSERM, F-75018 Paris, France
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Forey PL, Lallemant M, Bourtembourg-Matras A, Eckman-Lacroix A, Ramanah R, Riethmuller D, Mottet N. Impact of a selective use of episiotomy combined with Couder's maneuver for the perineal protection. Arch Gynecol Obstet 2020; 302:77-83. [PMID: 32388778 DOI: 10.1007/s00404-020-05572-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the impact of a selective use of episiotomy combined with Couder's maneuver on the incidence of perineal tears in spontaneous term deliveries. METHODS A comparative, retrospective, mono-centric study in a university maternity unit was designed and included all primiparous women who delivered spontaneously after 37 weeks of gestation in cephalic presentation. Two cohorts were studied, before and after the practice of Couder's maneuver. In the first cohort, the ''OSE cohort'' only selective episiotomies were performed from January 2009 to December 2010. In the second cohort, from January 2016 to December 2017, the ''SEC cohort'' selective episiotomies combined with Couder's maneuver were performed by midwives and obstetricians. The primary outcome was the type of perineal tears, according to the Royal College of Obstetricians and Gynaecologists (RCOG) classification. RESULTS A total of 2081 patients were included: 909 patients in the OSE cohort and 1172 patients in the SEC cohort. Couder's maneuver was performed in 59% of the SEC cohort. In the SEC cohort, there were an increase in the number of intact perinea (55% versus 63%, p < 0.001), a decrease in second-degree perineal tears (18% versus 11%, p < 0.001) and a decrease in labia minora tears (48% versus 37%, p < 0.001). The rate of obstetrical anal sphincter injuries was less than 1% in both cohorts (0.3% versus 0.5%, p = 0.7). CONCLUSION A selective use of episiotomy combined with Couder's maneuver could reduce the incidence of perineal tears, particularly second-degree perineal tears, without increasing the rate of obstetrical anal sphincter injuries.
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Affiliation(s)
- Pierre-Louis Forey
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Marine Lallemant
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Aude Bourtembourg-Matras
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Astrid Eckman-Lacroix
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
- Nanomedecine Laboratory, Imagery and Therapeutics, INSERM EA 4662, University of Franche-Comté, 25000, Besançon, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France.
- Nanomedecine Laboratory, Imagery and Therapeutics, INSERM EA 4662, University of Franche-Comté, 25000, Besançon, France.
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Gachon B, Charveriat A, Pierre F, Fritel X. [National survey about the practice of episiotomy within French National College of Obstetricians and Gynecologists (CNGOF)]. ACTA ACUST UNITED AC 2019; 47:627-636. [PMID: 31255835 DOI: 10.1016/j.gofs.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The main endpoint was to perform a survey about the practices of episiotomy into a CNGOF (National College of French Obstetricians and Gynecologists) members population. METHODS In November 2018, it was proceeded to a national survey from CNGOF members thanks to an online questionnaire. We collected prospectively: the answerer's characteristics, the rate of episiotomy and its systematics indications for spontaneous and operative delivery, the habits of the practitioners for the section and the reparation, the modalities of women's information and the data entered into the medical record. RESULTS Three hundred and eighty nine CNGOF members answered to the survey. They were 69% to declare performing less than 10% of episiotomy in case of spontaneous vertex delivery. The most frequent systematic indication of episiotomy was the personal history of obstetric anal sphincter injury (more than 30% of answerers). Systematic episiotomy was less frequent in case of vacuum assisted operative delivery compared to forceps (OR=0.18 [0.08-0.37]) or spatulas (OR=0.28 [0.12-0.59]). Most of practitioners (94%) declared performing mediolateral episiotomies, 64% declared cutting with an equal or more than 45° angle and 50% declared using a resorbable continuous suture technique for the reparation. Half of the answerers (46%) indicated that they inform et collected women's consent before performing an episiotomy. CONCLUSIONS Several practices, women's information, section angle and the reparation technique are subject to change by the latest 2018 CNGOF guidelines about perineal protection.
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Affiliation(s)
- B Gachon
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Laboratoire « Mouvement, Interactions, Performance » EA 4334, Faculté des sciences du sport, Université de Nantes, 25, boulevard Guy-Mollet, 44322 Nantes, France; Centre d'investigation clinique pluri-thématique du CHU de Poitiers, Inserm 1402, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - A Charveriat
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - F Pierre
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - X Fritel
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Centre d'investigation clinique pluri-thématique du CHU de Poitiers, Inserm 1402, 2, rue de la Milétrie, 86000 Poitiers, France; CESP UMR Inserm U1018, Équipe 7: Genre, santé sexuelle et reproductive, 94270 Le Kremlin Bicêtre, France
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Tourrilhes E, Veluire M, Hervé D, Nohuz E. [Obstetric outcome of women with primary vaginismus]. Pan Afr Med J 2019; 32:160. [PMID: 31303929 PMCID: PMC6607310 DOI: 10.11604/pamj.2019.32.160.16083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/12/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Dysfonction importante, le vaginisme est un problème tant individuel que du couple qui peut altérer la relation sexuelle. Il peut influencer le pronostic obstétrical. Le but de cette étude était de déterminer si les caractéristiques cliniques du vaginisme ont une incidence sur le processus de l’accouchement. Méthodes Etude rétrospective multicentrique incluant des patientes affectées par un vaginisme primaire, ayant donné naissance à terme à un premier enfant vivant, entre 2005 et 2015. Résultats Sur les 19 patientes inclues dans l’étude, nous avons constaté 9 grossesses prolongées, 14 mises en travail spontanées (dont 8 à terme atteint), 3 césariennes en dehors du travail et 2 déclenchements artificiels. Parmi les 16 femmes ayant eu un travail, nous avons dénombré 4 césariennes, 5 accouchements par voie basse avec forceps et 7 par voie basse spontanée. Parmi les 12 accouchements par voie basse, 9 épisiotomies ont été pratiquées, 7 femmes ont présenté des déchirures périnéales spontanées seules ou associées à une épisiotomie, aucune lésion périnéale de type 3 ou 4, ni de périnées intacts n’ont été recensés. Le poids moyen des nouveau-nés était de 3380g±332 (2870g-3970g, 47e percentile). Conclusion La proportion d’accouchements dystociques et la morbidité périnéale étaient notablement élevées, ce qui parait comparable avec la plupart des données de la littérature. Il est possible que les composantes psychologiques et comportementales du vaginisme, (mécanisme de peur-évitement, anxiété) aient favorisé les grossesses prolongées, les césariennes, les dystocies mécaniques et les lésions périnéales. Des études complémentaires sont nécessaires afin de mieux cerner le vaginisme et ses implications obstétricales.
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Affiliation(s)
- Elise Tourrilhes
- Service de Gynécologie Obstétrique, Centre Hospitalier de Fougères, Fougères, France
| | - Marie Veluire
- Service de Gynécologie Obstétrique, Hôpital Privé d'Athis-Mons, Caron, 91200 Athis Mons, France
| | - David Hervé
- Service de Gynécologie Obstétrique, Hôpital Privé d'Athis-Mons, Caron, 91200 Athis Mons, France
| | - Erdogan Nohuz
- Université Clermont-Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France.,Service de Gynécologie Obstétrique, Centre Hospitalier de Thiers, Route du Fau, 63300 Thiers, France
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Hulot G, Ramanah R, Riethmuller D, Mottet N. The impact of active delivery of the anterior arm during vacuum-assisted vaginal delivery on perineal tears: a clinical practice evaluation. J Matern Fetal Neonatal Med 2019; 33:3308-3312. [PMID: 30714443 DOI: 10.1080/14767058.2019.1571573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: Our purpose was to evaluate the impact of active delivery of the anterior arm with Couder's Maneuver (CM) during vacuum-assisted vaginal delivery (VAVD) on perineal tears. This maneuver can be beneficial because it has the advantage of reducing fetal biacromial diameter.Methods: This monocentric retrospective study compared two non-concurrent cohorts of nulliparous women before and after implementation of a systematic CM during VAVD: Cohort 1 from 1 January to 31 December 2006 without CM and Cohort 2 from 1 January to 31 December 2016 with systematic CM. This study reviewed all births during these two periods. All live-born singleton pregnancies where VAVD occurred after 37 weeks of gestation were included. The principal endpoint was the type of perineal tear.Results: In total, there were 179 VAVD in the Cohort 1 and 267 VAVD in the Cohort 2. In the Cohort 2, 233 VAVD (87.3%) were performed with systematic CM. No episiotomy was performed in both cohorts. There was a significant decrease in the rate of second-degree perineal tears between the two cohorts (42.4 versus 15%, p < .001) and a significant increase in the rate of intact perineum (34.1 versus 54.7%, p < .001). There was no influence of CM on the rate of obstetrical anal sphincter injury (3.9 versus 2.6%, p = .44).Conclusions: Practicing this maneuver could improve the perineal prognosis during VAVD in nulliparous women.
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Affiliation(s)
- Ghislain Hulot
- Department of Obstetrics and Gynecology, Besançon University Medical Center, Besançon, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynecology, Besançon University Medical Center, Besançon, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynecology, Besançon University Medical Center, Besançon, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, Besançon University Medical Center, Besançon, France
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12
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Riethmuller D, Ramanah R, Mottet N. [Fetal expulsion: Which interventions for perineal prevention? CNGOF Perineal Prevention and Protection in Obstetrics Guidelines]. ACTA ACUST UNITED AC 2018; 46:937-947. [PMID: 30377094 DOI: 10.1016/j.gofs.2018.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective for all obstetricians and midwifes who intervene during the release of the fetal presentation is to prevent at best the perineal lesions. This work consisted in analyzing the literature, researching and evaluating interventions that reduce this perineal risk during the release. METHODS A keyword search for each medical intervention during the expulsion phase was conducted by selecting studies assessing perineal risk. Interventions during pregnancy and during delivery before the expulsion phase were specifically addressed in other sections of the recommendations. RESULTS Firstly, the degree of perineal stretching during the second stage of labour does not appear to be a risk factor for OASIS, postpartum incontinence, or sexual disorders (LE3) and that a substantial stretching of the perineum is not an indication of episiotomy (Professional consensus). Then, manual control of the expulsion of the fetus at the end of the second stage of labour and support of the posterior perineum during this time appear to reduce the rate of OASIS (LE3). The crowning of the baby's head should be manually controlled and the posterior perineum manually supported manually to reduce the risk of OASIS (GradeC). There is no recognised benefit to episiotomy in normal deliveries (LE1); the liberal practice of episiotomy results in fewer intact perineums than its restrictive practice, and the latter does not result in increasing the number of cases of OASIS. No evidence indicates that an episiotomy for women with a breech presentation, twin pregnancy, or posterior position prevents OASIS (LE3). Indication for episiotomy during delivery depends on individual risk factors and obstetric conditions (Professional consensus). It is recommended that the indication for episiotomy be explained and the woman's consent received before its performance. The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). The liberal practice of episiotomy to prevent OASIS is not recommended for women with a breech presentation, twin pregnancy, or posterior position (GradeC). Episiotomy during an instrumental delivery appears to be associated with a reduction of the risk of OASIS (LE3). The vacuum extractor appears to induce fewer cases of OASIS than other instruments (LE3). Episiotomy may be indicated in instrumental deliveries to avoid OASIS (GradeC). Training in perineal protection in obstetrics is recommended (Grade B). In operative vaginal deliveries when several instruments can be used, a vacuum extractor is preferentially recommended to reduce the risk of OASIS (GradeC). When forceps or spatulas are used, it is preferable that they be withdrawn just before cephalic deflexion so that the fetal head is not "capped" with these instruments at birth (Professional consensus). Couder's maneuver, which consists of lowering the forearm during the release of the fetal shoulders, appears to decrease the rate of second-degree perineal tears and increase the rate of intact perineum (LE3). CONCLUSION Manual control of the expulsion and perineal support reduce the risk of perineal injury. There is no benefit to episiotomy in normal delivery, nor in special cases such the breech presentation for example. On the other hand, in case of instrumental delivery, an episiotomy may be indicated to avoid OASIS (GradeC), and it is recommended if it is possible to use the ventouse preferentially. The Couder's maneuver seems to reduce the rate of 2nd degree perineal lesions (LE3). Finally, training in perineal obstetric protection is recommended (Grade B).
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Affiliation(s)
- D Riethmuller
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France.
| | - R Ramanah
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - N Mottet
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
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Bourgon N, Mottet N, Bourtembourg A, Pugin A, Ramanah R, Riethmuller D. [Obstetrical anal sphincter injuries and vacuum-assisted delivery at term in primiparas]. ACTA ACUST UNITED AC 2018; 46:686-691. [PMID: 30293947 DOI: 10.1016/j.gofs.2018.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Operative Vaginal Delivery (OVD) is subject to a risk of perineal tears especially of Obstetrical Anal Sphincter Injuries (OASIS) that are associated with more complications and impaired quality of life. The main objective of this study was to compare the rate of OASIS in primipara at term with fetus in cephalic presentation depending on the type of delivery: OVD using vacuum extractor and spontaneous delivery. METHODS This is a single-center retrospective study between 01/01/2010 and 12/31/2014 including all primipara who delivered vaginally at term, a single and living fetus in cephalic presentation. Perineal lesions were classified according to the WHO classification. The primary endpoint was the proportion of OASIS. RESULTS 3552 patients were included: 2496 spontaneous deliveries (SD) and 1056 OVD (29.72 %). There were twenty sphincter tears (0.56 %): 7 in SD group (0.28 %) and 13 in OVD (1.23 %), P<0.0001, OR=5.10 [2.00; 12.99]. Other risk factors associated with OASIS in univariable analysis were: maternal age (≥30 years), duration of expulsive efforts (≥20min) and a birth weight≥4000g. CONCLUSION In these patients, the risk of OASIS in case of AI increases by a factor of 5;10. The high rate of AI in these patients exposes them to a real risk of OASIS. However, the proportion of OASIS in this group remains lower than those reported in the literature and is barely higher than the national overall rate, despite a very restrictive policy of the use of episiotomy.
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Affiliation(s)
- N Bourgon
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - N Mottet
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - A Bourtembourg
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - A Pugin
- Centre d'investigation clinique, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - R Ramanah
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - D Riethmuller
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France.
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Abedzadeh-Kalahroudi M, Talebian A, Sadat Z, Mesdaghinia E. Perineal trauma: incidence and its risk factors. J OBSTET GYNAECOL 2018; 39:206-211. [DOI: 10.1080/01443615.2018.1476473] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Ahmad Talebian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Zohreh Sadat
- Nursing Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Elaheh Mesdaghinia
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Mottet N, Bonneaud M, Eckman-Lacroix A, Ramanah R, Riethmuller D. Active delivery of the anterior arm and incidence of second-degree perineal tears: a clinical practice evaluation. BMC Pregnancy Childbirth 2017; 17:141. [PMID: 28499362 PMCID: PMC5429558 DOI: 10.1186/s12884-017-1322-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluate the feasibility of active delivery of the anterior arm during spontaneous delivery. This maneuver could decrease incidence of second-degree perineal tears because it reduces fetal biacromial diameter. METHODS An observational comparative prospective study was conducted at our teaching maternity from July 2012 to March 2013. The study included 199 nulliparous women ≥18 years, who met the following criteria: singleton pregnancy, vaginal delivery with occiput anterior presentation, on epidural analgesia, from 37 weeks of gestation onward. The distribution of rate and type of perineal tears were compared between two groups: a non-exposed group and a group exposed to the maneuver. RESULTS A total of 101 patients were exposed to Couder's maneuver (CM) and 98 patients were not exposed. In the intervention group, 3 failures of the maneuver were reported. The maneuver was considered easy in 80% of cases, moderately easy in 12% and difficult in 8% of cases. There was a significant difference (p = 0.03) in the distribution of perineal tears between the two groups. There was a significant reduction (p < 0.001) in the number of second-degree perineal tears in the patients exposed to CM. There was no significant difference in the rate of anterior perineal trauma between the exposed and non-exposed arms. CONCLUSIONS CM in primiparous women at term is feasible with a low failure rate and influences the distribution of perineal tears by lowering second-degree perineal tears in a highly significant manner (p <0.01).
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Affiliation(s)
- Nicolas Mottet
- Department of Obstetrics and Gynecology- Besancon University Medical Center, CHRU Jean Minjoz, Alexander Fleming Boulevard, 25000 Besancon, France
| | - Marine Bonneaud
- Department of Obstetrics and Gynecology- Besancon University Medical Center, CHRU Jean Minjoz, Alexander Fleming Boulevard, 25000 Besancon, France
| | - Astrid Eckman-Lacroix
- Department of Obstetrics and Gynecology- Besancon University Medical Center, CHRU Jean Minjoz, Alexander Fleming Boulevard, 25000 Besancon, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynecology- Besancon University Medical Center, CHRU Jean Minjoz, Alexander Fleming Boulevard, 25000 Besancon, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynecology- Besancon University Medical Center, CHRU Jean Minjoz, Alexander Fleming Boulevard, 25000 Besancon, France
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16
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[Can the rate of episiotomy still be lowered? Status update in PACA region (south of France)]. ACTA ACUST UNITED AC 2017; 45:146-151. [PMID: 28682756 DOI: 10.1016/j.gofs.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/03/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate professional practices relative to episiotomies in the Provence Alpes Côte d'Azur (PACA) region by analysing their incidence in maternity hospitals, by type and by sector of activity. Following this, to analyse maternal and obstetric characteristics associated with episiotomies and the occurrence of perineal tears in Marseille's university hospitals (CHU). METHODS Data were extracted from the database for the period from 1st January 2012 to 31 December 2014. The sample included 41 maternity hospitals: 13 private and 28 public. Twenty of the maternity hospitals were level 1, 15 were level 2, and 2 were level 3 (Nice and AP-HM). RESULTS In the PACA region, 176,573 patients gave birth by vaginal delivery. The incidence of episiotomy over the 3 years was 21.6% (0.50% - 76.13%) with a statistically significant reduction in the incidence between 2012 and 2014 (P<0.001). There was a significant difference by sector (P<0.001) and level (P<0.001) of maternity hospitals. In the Marseille CHU, 21.6% of women had an episiotomy (66.4% in primiparas - 33.6% in multiparous) and 43% had perineal tears (62.3% in primiparas - 37.7% in multiparous). After multivariate analysis, gender, weight of the newborn, presentation, gestational age, and mode of delivery were shown to be factors significantly associated with occurrence of episiotomy and occurrence of perineal tear (P<0.001). CONCLUSION A significant decrease in the incidence of episiotomy was observed in the PACA region from 2012 to 2014, associated with a wide variation in rates depending on the maternity hospitals, their types and their sectors.
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Guerby P, Allouche M, Simon-Toulza C, Vayssiere C, Parant O, Vidal F. Management of persistent occiput posterior position: a substantial role of instrumental rotation in the setting of failed manual rotation. J Matern Fetal Neonatal Med 2017; 31:80-86. [DOI: 10.1080/14767058.2016.1275552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Paul Guerby
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
| | - Mickael Allouche
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
| | - Caroline Simon-Toulza
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
| | - Christophe Vayssiere
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
- UMR 1027 INSERM, University Paul Sabatier Toulouse III, Toulouse, France
| | - Olivier Parant
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
- UMR 1027 INSERM, University Paul Sabatier Toulouse III, Toulouse, France
| | - Fabien Vidal
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
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18
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Ginod P, Khallouk B, Benzenine E, Desplanches T, Dub T, Schmutz E, Douvier S, Sagot P. [Assessment of restrictive episiotomy use and impact on perineal tears in the Burgundy's Perinatal Network]. ACTA ACUST UNITED AC 2016; 45:1165-1171. [PMID: 27720515 DOI: 10.1016/j.jgyn.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 07/10/2016] [Accepted: 08/30/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyse episiotomy and perineal tears rates in Burgundy after French National College of Obstetricians and Gynecologists (CNGOF) guidelines in 2005. MATERIALS AND METHOD Multicenter retrospective study, between 2003-2005 (period 1) et 2012-2014 (period 2), conducted on singletons vaginal deliveries, in cephalic presentation from 37 weeks. We compared the episiotomy rate (ER), and perineal lesions in normal deliveries (ND) and instrumental deliveries (ID) between the two periods. RESULTS A total of 74,268 women were included. The overall ER significantly decreased from 35.8 to 16.7% (P<0.01), without increasing third degree perineal tears (0.73% vs. 0.66%) or fourth degree (0.14% vs 0.14%). First degree perineal tears rose (42.1% vs 17.6%, P<0.001), second degree decreased (13.5% vs 20.5%, P<0.001). ER decreased whatever the level of motherhood, healthcare ward, vaginal delivery type, or the instrument used. CONCLUSION Our study found a strong impact in Burgundy of the French guidelines for the practice of restrictive episiotomy for both ND and for ID without increasing sphincter tears and in decreasing spontaneous morbidity.
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Affiliation(s)
- P Ginod
- Service de gynécologie-obstétrique, CHU F.-Mitterand, 14, rue Gaffarel, 21000 Dijon, France.
| | - B Khallouk
- Service de gynécologie-obstétrique, CHU F.-Mitterand, 14, rue Gaffarel, 21000 Dijon, France
| | - E Benzenine
- Réseau périnatal de Bourgogne, 4, boulevard Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France
| | - T Desplanches
- Réseau périnatal de Bourgogne, 4, boulevard Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France
| | - T Dub
- Hotel-Dieu, Assistance publique-Hôpitaux de Paris, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France
| | - E Schmutz
- Service de gynécologie-obstétrique, CHU F.-Mitterand, 14, rue Gaffarel, 21000 Dijon, France
| | - S Douvier
- Service de gynécologie-obstétrique, CHU F.-Mitterand, 14, rue Gaffarel, 21000 Dijon, France
| | - P Sagot
- Service de gynécologie-obstétrique, CHU F.-Mitterand, 14, rue Gaffarel, 21000 Dijon, France
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Chuilon AL, Le Ray C, Prunet C, Blondel B. L’épisiotomie en France en 2010 : variations des pratiques selon le contexte obstétrical et le lieu d’accouchement. ACTA ACUST UNITED AC 2016; 45:691-700. [DOI: 10.1016/j.jgyn.2015.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/13/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
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20
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Évaluation des spatules de Teissier dans l’accouchement assisté des fœtus prématurés. ACTA ACUST UNITED AC 2016; 45:592-8. [DOI: 10.1016/j.jgyn.2015.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 06/04/2015] [Accepted: 06/18/2015] [Indexed: 11/17/2022]
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Clesse C, Lighezzolo-Alnot J, Hamlin S, De Lavergne S, Scheffler M. [The practice of episiotomy in France 10 years after the recommendations of CNGOF: What inventory?]. ACTA ACUST UNITED AC 2016; 44:232-8. [PMID: 26997462 DOI: 10.1016/j.gyobfe.2016.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 02/09/2016] [Indexed: 12/14/2022]
Abstract
Since its creation, the practice of episiotomy has evolved, being influenced by several factors. Various stances on its use were stated, until the eventual reduction of this practice, as suggested by numerous practical guides. In 2005, the National College of Obstetricians and Gynecologists in France published its French Guidelines for Clinical practice in this area. Today, it seems appropriate to focus on the evolution of the use of episiotomy, ten years after the publication of these recommendations. The authors propose a literature review, browsing through all the available epidemiological data in France related to episiotomy, recording all national statistics and some local trends, as there are regional specificities. This review allows to follow the overall evolution of the practice of episiotomy in France between 1981 and 2014, and to identify territorial disparities. Finally, in the specific context of the practice of episiotomy in French gynecological and obstetrics field, the authors conclude it by considering the possible evolution of this surgical practice, as well as, the Clinical Practice Recommendations related to it.
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Affiliation(s)
- C Clesse
- Laboratoire interpsy (EA4432), université de Lorraine, Nancy 2, 3, place Godeffroy-de-Bouillon, 54000 Nancy, France; Centre hospitalier de Jury-les-Metz, route d'Ars-Laquenexy, BP 75088, 57073 Jury-Les-Metz cedex 03, France.
| | - J Lighezzolo-Alnot
- Laboratoire interpsy (EA4432), université de Lorraine, Nancy 2, 3, place Godeffroy-de-Bouillon, 54000 Nancy, France
| | - S Hamlin
- Polyclinique Majorelle, 1240, avenue Raymond-Pinchard, 54100 Nancy, France
| | - S De Lavergne
- Polyclinique Majorelle, 1240, avenue Raymond-Pinchard, 54100 Nancy, France
| | - M Scheffler
- Polyclinique Majorelle, 1240, avenue Raymond-Pinchard, 54100 Nancy, France; Cabinet de gynécologie médicale et obstétrique, 21, avenue Foch, 54000 Nancy, France
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Toubin C, Mottet N, Chehab M, Maurice M, Ramanah R, Riethmuller D. Influence d’une forte diminution du recours à l’épisiotomie appliquée à une situation à haut risque périnéal : le dégagement en occipito-sacré. ACTA ACUST UNITED AC 2015; 44:855-61. [DOI: 10.1016/j.jgyn.2014.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 12/10/2014] [Accepted: 12/22/2014] [Indexed: 11/28/2022]
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