A welcome challenge to systematic episiotomy
In 2018, the High Authority of Health put a brake on the systematic practice of episiotomy, including among primiparous women (women who are having their first childbirth), by recommending its restrictive use. These recommendations were in agreement with those formulated by the National College of French Obstetrician Gynecologists (CNGOF) several years earlier. While this contested practice has clearly declined, French and Swiss researchers wanted to verify whether the cessation of its practice had not led to an increase in lesions of the anal sphincter in women giving birth.
What did the researchers discover?
They analyzed the medical records of 29,750 women who had vaginal births, using data from the French National Perinatal Surveys of 2010, 2016 and 2021. They examined the prevalence of episiotomy and obstetric anal sphincter injuries, in function of different obstetric contexts (in nulliparous women with a single fetus, forceps delivery, or in women who have already had vaginal births, etc.). They also took into account changes in maternal characteristics and obstetrical practices. In 2010, 25.8% of vaginal deliveries resulted in an episiotomy. This rate decreased considerably, dropping to 20.1% in 2016, then to 8.3% in 2021.
No more anal sphincter damage
The results show a reduction in the overall prevalence of episiotomy (less than 10% overall), without there being a corresponding increase in anal sphincter injuries. However, in one group, that of nulliparous women (having never given birth before) giving birth by spatulas of a single, full-term child in cephalic presentation (head first), the rate of lesions was multiplied by 2 or 3 Precisely, the prevalence of obstetric anal sphincter injuries increased in this group alone, from 2.6% in 2010 to 9.6% in 2021, while. that the episiotomy rate fell from 78.8% to 31.7%.
-What should be done in the event of instrumental delivery in nulliparous women?
The implementation of a restrictive episiotomy policy therefore proved effective: the number of unnecessary episiotomies fell, which met women’s expectations. What is positive, contrary to an argument made in the past by many voices, is that this reduction has not been systematically associated with an increase in lesions of the obstetric anal sphincter.
However, the results “suggest that it is necessary to review the restrictive policy indications for instrumental deliveries in nulliparous women,” the authors conclude. Which specifies: “the conclusions must be interpreted with caution due to the low number of cases of lesions in certain subgroups. Future studies, with a high level of evidence, are needed to determine the optimal rate of episiotomy in nulliparous women requiring instrumental delivery. »
Flu epidemic: vaccination of seniors, a public health imperative?
Source: Destination Santé
