rates decreased without leading to an increase in serious perineal tears

In the early 2000s, healthcare professionals almost systematically cut the perineum of pregnant women during vaginal deliveries. It has a name: episiotomy. The purpose of this intervention? Helping the baby come out more quickly and easily, especially in life-threatening emergencies, and preventing obstetric damage to the anal sphincter, resulting from pushing effort, which impacts the health and well-being of patients in the short and long term. Problem: this “routine practice”according to Thomas Desplanches, professor at the Haute Ecole de santé de Genève (HEdS) and associate researcher in pediatric and perinatal epidemiology at Paris Cité University, has not proven itself scientifically speaking and “can be experienced as a violent gesture.” This is why, since 2005, French health authorities have recommended restricting the performance of episiotomy.

Episiotomy: the medical records of 29,750 women who gave birth vaginally were analyzed

In a recent study, published in the journal Plos MedicineThomas Desplanches and a team of French researchers wanted to evaluate variations in the prevalence of episiotomy and obstetric lesions of the anal sphincter. To do this, they used data from the National Perinatal Surveys of 2010, 2016 and 2021. More precisely, they reviewed the medical records of 29,750 women who gave birth to a child living vaginally in order to identify episiotomies. and obstetric injuries to the anal sphincter. “We described the overall prevalence of outcomes and then the obstetric clinical contexts using an obstetric classification of women into seven groups. Variations between years were analyzed by testing and using models adjusted to the maternal age, BMI, country of birth, prenatal classes, suspected fetal macrosomia and neuraxial analgesia during labor, professional who attended the delivery, annual number of deliveries and the status of maternity.

Episiotomies only concern 8.3% of deliveries in 2021

The research found that the overall prevalence of episiotomy had decreased significantly from 25.8% in 2010 to 20.1% in 2016 and 8.3% in 2021. This reduction was observed in all classification groups. According to the authors, this drop in the episiotomy rate is not necessarily followed by an increase in obstetric injuries to the anal sphincter. In detail, the prevalence of perineal tears only increased significantly in the group composed of nulliparous women who gave birth to a single child at term and who needed forceps or spatulas, going from 2.6% in 2010 to 9.6% in 2021.

“Our results should be interpreted with caution given obstetric anal sphincter injuries in some subgroups. Further research is needed to predict the optimal episiotomy rate for instrumental deliveries. In hospitals where episiotomy rates are high, our data suggest that episiotomy could be safely reduced for vaginal deliveries to comply with international recommendations and women’s demands. can we read in the works.