Abstract
<i>Objective</i>: In December 2018, new recommendations from the National College of French Obstetrician Gynaecologists restricted obstetric indications for episiotomy to only instrumental delivery, to avoid the occurrence of obstetric lesions of the anus sphincter. In our maternity wards, episiotomy is still performed liberally in the face of high-risk perineal situations, without significant reduction in perineal tears. This is how the present study set itself the objective of evaluating the impact of a restrictive practice of episiotomy on the perineum. <i>Methods</i>: Before-after non-experimental evaluative study, conducted from March 1 to August 30, 2019, in two maternity hospitals in Brazzaville, comparing according to a 1/1 ratio, after matching age and parity, 300 parturient with a high situation perineal risk of episiotomy having benefited from a procedure restricting episiotomy to 300 others who did not benefit. The two groups were evaluated: the percentage of episiotomy, the percentage, and the degree of perineal tears. The effect of the restriction was assessed by calculations of the difference in absolute risk (DR), reduction in relative risk (RRR) and the number of subjects required to treat (NST). <i>Results</i>: Parturient with high perineal risk had a median age of 23 years (18-28) and were primiparous (0-1.5). The high perineal risk situations were dominated in the two groups by the maternal indications concerning parity (nulliparity: 40% vs 63%) and the perineum (scar: 51% vs 60%); followed by macrosomia (25% vs 38%) and prematurity (25% vs 16%) as fetal indications. The episiotomy was performed in all cases of instrumental forceps extraction (1.3% vs 5%). The restrictive practice of episiotomy was effective in 96% of cases with 69.8% of intact perineum vs 19%. It had a protective effect on the perineum, making it possible to avoid the occurrence of 82 episiotomies (DR=-82% [-93, -70]; RRR=95%) and 50 perineal tears (DR=-50% [-66, -34]; RRR=63%) for 100 parturient. To avoid an episiotomy and a perineal tear, the restriction procedure must be applied to an average of 1.2 parturient (NST=-1.2) and two parturient (NST=-2), respectively. <i>Conclusion</i>: It is entirely possible to opt for a restrictive practice of episiotomy in our maternities by rigorously and meticulously evaluating the perineal risks and by respecting the procedures for protecting the perineum during childbirth.
Highlights
Episiotomy is an operation which consists in cutting the perineum starting from the posterior commissure of the vulva, involving the skin, the vaginal mucosa, the superficial muscles of the perineum and the entire pubo-rectal bundle [1]
Several studies have called into question his liberal practice, since it neither protects from serious perineal tears nor from its sequelae on continence [3,4,5], the 2005 recommendations of the National College of Obstetric Gynecology of France (CNGOF) promoting a restrictive practice of episiotomy [4]
Compared to parturient who were the subject of a liberal practice of episiotomy, the practice of the episiotomy procedure during the study period, had a protective effect on the perineum, making it possible to avoid the occurrence of 82 episiotomies and 50 perineal tears for 100 parturient
Summary
Episiotomy is an operation which consists in cutting the perineum starting from the posterior commissure of the vulva, involving the skin, the vaginal mucosa, the superficial muscles of the perineum and the entire pubo-rectal bundle [1]. Several studies have called into question his liberal practice, since it neither protects from serious perineal tears nor from its sequelae on continence [3,4,5], the 2005 recommendations of the National College of Obstetric Gynecology of France (CNGOF) promoting a restrictive practice of episiotomy [4]. Episiotomy is still performed liberally in the face of high-risk perineal situations, without significant reduction in perineal tears.
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