Practice Of Episiotomy Research Articles

The barriers and facilitators to evidence-based episiotomy practice in Jordan.

This paper examines the barriers to evidence-based episiotomy practice in Jordan and identifies strategies that may be effective in introducing evidence-based practice. Episiotomy is routinely undertaken during birth in many parts of the world, including in the Middle East with little scientific evidence of benefit. There is a paucity of research examining the underlying drivers for episiotomy rates, and why they are higher in some countries. This study, conducted in Jordan, used a quality improvement approach and comprised three phases. In phase one, a retrospective file review of 300 births was conducted. In phase two, 15 face-to-face interviews were conducted with 10 midwives and five key stakeholders (managers and doctors). A feedback and discussion session using the audit and review model was conducted in phase three with 23 health professionals to identify strategies to reduce the episiotomy rate. The episiotomy rate was 41.4% overall (91% of primiparous women and 24% of multiparous women). Six major themes emerged from the thematic analysis of data: 'Policy: written but invisible and unwritten and assumed'; 'the safest way'; 'doctors set the rules'; 'midwives swimming with the tide; 'uncooperative and uninformed women' and 'the way forward'. Non-evidence based episiotomy practices are widely used during birth in this Jordanian hospital and numerous barriers to change exist. Medical professionals dictate childbirth practice and midwives fear recrimination if they go against the 'unwritten policy'. Strategies to change practice include development of evidence-based information for women, education of midwives and doctors, and policy review.

Routine Episiotomy Practice at a Tertiary Care Center in Saudi Arabia

Background: Episiotomy is a common perineum incision preformed to facilitate the delivery. Although it was commonly performed especially in primigravida women, the new trend is to limit episiotomies as much as possible. This study aimed to find out the rate of episiotomy and to compare the rate in primigravida vs multigravida at King Abdulaziz university hospital. Methods: A retrospective chart review was performed at King Abdulaziz University Hospital, Jeddah from January 2012 to December 2015. Ethical approval was obtained. Results: 35% of the females in 2012 had episiotomy while the majority of the vaginal deliveries had no intervention (65%). In 2015, the rate of episiotomies has increased to 36.4%. However, the majority of the vaginal deliveries had no intervention (63.6%). Overall 87.6% primigravidas had episiotomy while only 12.4% delivered without intervention. On the other hand, only 16.1% multigravidas had episiotomy, while the largest portion of cases was delivered without intervention (83.9%). Conclusion: Rate of episiotomy has slightly increased in 2015 in comparison to 2012. To decrease the overall episiotomy rate, we have to review KAUH guidelines and evaluate the limitation of applying it in practice.

Pattern of episiotomy use & its immediate complications among vaginal deliveries in 18 tertiary care hospitals in India.

Background & objectives:In developed countries, efforts have been made to restrict episiotomy practice. However, in developing countries the episiotomy rates continue to be high. This study was conducted to evaluate the pattern of episiotomy use and its immediate complications among women delivering at tertiary level public hospitals in India.Methods:Prospective data of all women undergoing vaginal delivery including instrumental delivery were collected daily from the labour room registers of the 18 tertiary care hospitals on a structured proforma. Weekly data from all sites were sent to a central unit for compilation and analysis. Odds ratio was used to compare the proportion of genital trauma among women with and without episiotomy both in nulliparous and multiparous women.Results:Among 1,20,243 vaginal deliveries, episiotomy was performed in 63.4 per cent (n=76,305) cases. Nulliparaous women were 8.8 times more likely to undergo episiotomy than multiparous women. The various genital tract injuries reported were first degree perineal tear (n=4805, 3.9%), second degree perineal tear (n=1082, 0.9%), third and fourth degree perineal tear (n=186, 0.2%), anterior vaginal trauma requiring suturing (n=490, 0.4%), extension of episiotomy/vaginal laceration/excessive bleeding from episiotomy or tear (n=177, 0.15%), vulval/vaginal haematoma (n=70, 0.06%) and cervical tear (n=108, 0.08%). The combined rate of third and fourth degree perineal tears was observed to be significantly lower (P<0.001) among nullipara who received episiotomy (0.13%) compared to those who delivered without episiotomy (0.62%).Interpretations & conclusions:Significantly lower rates of third or fourth degree perineal tear were seen among nulliparous women undergoing episiotomy. The risk and benefit of episiotomy and its complications need to be evaluated through randomized clinical trials in the Indian context.

Indications for episiotomy performance – a cross-sectional survey and review of the literature

Our objective was to assess the reported reasons for episiotomy performance in Israel and to review the relevant professional literature. Using anonymous questionnaires, a survey was conducted among obstetricians and midwives in four northern Israel hospitals, and the accoucheurs were asked to score their agreement with 13 proposed indications for episiotomy. Overall, 84 doctors and 32 midwives completed the questionnaires. 86.1% of the responders reported performing episiotomy in all or most cases of shoulder dystocia, and more than half reported performing it in most cases of vacuum deliveries, fetal macrosomia and advanced perineal tear in previous delivery. Subjective assessment of perineal characteristics constituted a justified reason for episiotomy for 15.8–43.9% of the accoucheurs. In conclusion, there is a wide variation in reported reasons for episiotomy between the obstetricians, and many of these indications are not congruent with international practice guidelines. Uniform protocols and educational programmes are needed to guide episiotomy practice.

Knowledge of puerperals about the practice of episiotomy

ABSTRACT Objective: recognizing what puerperals know about the practice of episiotomy. Method: this is a field research of a qualitative approach, with descriptive exploratory focus, having as study scenario the Tocogynecological Unit of the University Hospital of Santa Maria, and as participants mothers who experienced vaginal parturition with episiotomy. Data will be collected through a semi-structured interview consisting of closed questions in order to characterizing the research participants and through an open question in relation to the focus of this study, after, there will be analyzed by means of operative proposal. This project was approved by the Research Ethics Committee, CAAE 27353814.5.0000.5346. Expected results: creating subsidies for nursing care and for reflection of professionals and health managers about the theme, reformulating the use of interventional practices in the birth process. Descriptors: Nursing Care; Parturition; Episiotomy; Nursing. RESUMO Objetivo: conhecer o que as puerperas sabem sobre a pratica da episiotomia. Metodo: p esquisa de campo de abordagem qualitativa, com enfoque descritivo exploratorio, tendo como cenario de estudo a Unidade Tocoginecologica do Hospital Universitario de Santa Maria, e como participantes puerperas que vivenciaram o parto vaginal com episiotomia. Os dados serao coletados por meio de uma entrevista semiestruturada composta por perguntas fechadas com a finalidade de caracterizar os participantes da pesquisa e por uma questao aberta em relacao ao foco desse estudo, apos, serao analisados por meio da proposta operativa. Esse projeto foi aprovado pelo Comite de Etica em Pesquisa, CAAE 27353814.5.0000.5346 . Resultados esperados: c riar subsidios para o cuidado de enfermagem e para a reflexao dos profissionais e gestores de saude sobre a tematica, reformulando o uso de praticas intervencionistas no processo parturitivo. Descritores: Cuidados de Enfermagem; Parto; Episiotomia; Enfermagem. RESUMEN Objetivo: conocer lo que las madres recientes saben acerca de la practica de la episiotomia. Metodos: esta es una investigacion de campo de enfoque cualitativo, con enfasis descriptivo exploratorio, teniendo como escenario de estudio la Unidad de Tocoginecologica del Hospital de la Universidad de Santa Maria, y como los participantes madres recientes que experimentaron parto vaginal con episiotomia. Los datos se recogieron a traves de una entrevista semi-estructurada, se compone de preguntas cerradas con el fin de caracterizar los participantes en la investigacion y una pregunta abierta en relacion con el enfoque de este estudio, despues, van a ser analizados por medio de la propuesta operativa. Este proyecto fue aprobado por el Comite de Etica en la Investigacion, CAAE 27353814.5.0000.5346. Resultados esperados: crear subsidios para el cuidado de enfermeria y para la reflexion de los profesionales y gestores sanitarios acerca del tema, la reformulacion de la utilizacion de practicas de intervencion en el proceso del parto. Descriptores: Cuidados de Enfermeria; Parto; Episiotomia; Enfermeria. Normal 0 21 false false false PT-BR X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Tabela normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Times New Roman; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi;}

Predictors of routine episiotomy in primigravida women in Oman

PurposeEpisiotomy is still the most common surgical procedure performed on women, despite the evidence against its routine use. This cross-sectional study was conducted to determine the practice and predictors of routine episiotomy on primigravidae in Oman. MethodsDemographic data, reasons for and rate of performing routine episiotomies, and perceptions of 269 obstetricians, midwives and nurses from 11 hospitals in Oman regarding the procedure were recorded and analyzed. ResultsThe rate of episiotomies was 66%. In terms of performing routine episiotomies (p<0.05): non-Omanis were 4.49 times more likely than Omanis; bachelor's degree-holders were 2.26 more likely than diploma-holders; and regional hospitals were 2.36 times more likely than tertiary hospitals. The majority perceived episiotomies “reduce spontaneous perineal tearing risk”, “reduce shoulder dystocia complications”, and allow for “easier suturing”. ConclusionThe rate of episiotomies was higher than other similar contexts. An urgent intervention is necessary to curb this excessive practice, and create a culture of evidence-based practice to deal with misleading perceptions.

Cambios hematológicos originados por el parto eutocico

Se realizó un trabajo prospectivo en gestantes que concurrieron a emergencia del Hospital Maternidad de Lima en inicios de trabajo de parto. Al ingreso, se les realizó dosajes de hemoglobina y hematocrito y a las 48 horas del parto, se les tomó otra muestra de sangre, para nuevos dosajes, con el fin de investigar los cambios hematológicos que habían sufrido luego de un parto normal. Las que tuvieron parto distócico fueron desechadas, quedando la muestra constituida por 150 pacientes tomadas al azar, 56 de las cuales fueron primíparas y 94 fueron multíparas. La Hb. promedio antes del parto, fue de 10,89 ­± 1,57 gr. % y después del parto, fue de 9,95 ± 1.59 gr %. Se pudo ver, que el 71.3% de las pacientes tenían Hb. menor de 12 gr.% antes del parto y que el porcentaje de anémicas se incrementó a 88.7% en el post-parto. La proporción de anémicas en el pre y post-parto, según la edad materna, paridad, control pre-natal y con episiotomía, mostró diferencias estadísticamente significativas.

Knowledge, attitude and experience of episiotomy use among obstetricians and midwives in Viet Nam.

BackgroundEpisiotomy remains a routine procedure at childbirth in many South-East Asian countries but the reasons for this are unknown. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy use among clinicians in Viet Nam.MethodsAll obstetricians and midwives who provide delivery care at Hung Vuong Hospital were surveyed about their practice, knowledge and attitudes towards episiotomy use. Data were analysed using frequency tabulations and contingency table analysis.Results148 (88%) clinicians completed the questionnaire. Fewer obstetricians (52.2%) than midwives (79.7%) thought the current episiotomy rate of 86% was about right (P < 0.01). Most obstetricians (82.6%) and midwives (98.7%) reported performing episiotomies on nulliparous women over 90% of the time. Among multipara, 24.6% of obstetricians reported performing episiotomy less than 60% of the time compared with only 3 (3.8%) midwives (P < 0.01). Aiming to reduce 3rd-4th degree perineal tears was the most commonly reported reason for performing an episiotomy by both obstetricians (76.8%) and midwives (82.3%), and lack of training in how to minimize tears and keep the perineum intact was the mostly commonly reported obstacle (obstetricians 56.5%, midwives 36.7% P = 0.02) to reducing the episiotomy rate.ConclusionAlthough several factors that may impede or facilitate episiotomy practice change were identified by our survey, training and confidence in normal vaginal birth without episiotomy is a priority.

The correct episiotomy: does it exist? A cross-sectional survey of four public Israeli hospitals and review of the literature.

Our objective was to assess episiotomy technique used in Israeli hospitals, to determine factors influencing incision parameters, and to review relevant up-to-date professional literature. Using anonymous questionnaires, a survey was conducted among obstetricians and midwives in the four public hospitals in northern Israel over a 1-year period commencing in October 2013. In addition to demographic and professional data, the accoucheurs were asked to describe the technique they usually use to perform an episiotomy (length, angle, and distance of initiation point from midperineum). Overall, 84 obstetricians and 32 midwives participated in the survey. Only 37.6% reported performing a mediolateral episiotomy, while the rest described the lateral type, placing the initiation point at an average distance of 2.45 ± 0.88 cm from the fourchette. Compared with midwives, obstetricians reported performing a significantly longer episiotomy (3.53 ± 1.01 vs. 2.73 ± 0.81 cm, p = 0.0002). According to our study and relevant literature review, the technique of episiotomy varies significantly between health professionals and is not uniformly congruent with international practice guidelines. In part, this is derived from unclear literature evidence and lack of consensus definition for proper technique of this procedure by the national guidelines. Thus, further higher-quality research, uniform protocols, and educational programs are needed to guide episiotomy practice.

Reasons for routine episiotomy: A mixed-methods study in a large maternity hospital in Phnom Penh, Cambodia

First documented in 1741, the practice of episiotomy substantially increased worldwide during the 20th century. However, research shows that episiotomy is not effective in reducing severe perineal trauma and may be harmful. Using a mixed-methods approach, we conducted a study in 2013–14 on why obstetricians and midwives in a large maternity hospital in Phnom Penh, Cambodia, still do routine episiotomies. The study included the extent of the practice, based on medical records; a retrospective analysis of the delivery notes of a random sample of 365 patients; and 22 in-depth interviews with obstetricians, midwives and recently delivered women. Of the 365 women, 345 (94.5%, 95% CI: 91.7–96.6) had had an episiotomy. Univariate analysis showed that nulliparous women underwent episiotomy more frequently than multiparous women (OR 7.1, 95% CI 2.0–24.7). The reasons given for this practice by midwives and obstetricians were: fear of perineal tears, the strong belief that Asian women have a shorter and harder perineum than others, lack of time in overcrowded delivery rooms, and the belief that Cambodian women would be able to have a tighter and prettier vagina through this practice. A restrictive episiotomy policy and information for pregnant women about birthing practices through antenatal classes should be implemented as soon as possible.

Rates and Indicators for Episiotomy in Modern Obstetrics - a study from Saudi Arabia.

Background:This observational study aimed to describe the rates and indicators for practice of episiotomy during normal labour and to compare them between women who have had one pregnancy (PG) and women who have already delivered two or more children (G2 and above).Methods:The study was conducted at Mother and Child Hospital, Buraidah from October- December 2013 as a descriptive cross sectional study.Results:Overall rate of Episiotomy was 51.20%. Amongst the Primigravidas all went through episiotomies however in G2 and above only 7 patients (4.69%) delivered with episiotomy. Proportions tests revealed that there were significant differences between gravidity groups on two indications of episiotomy (vaginal breech p <0.001 and previous history of perineal tear p < 0.001). G2 and above had episiotomy for breech delivery (1 of 7 = 14.29%) significantly more often than PG participants (0 of 142 = 0.0%). And G2 and above participants experienced episiotomy for previous perineal tear (2 of 7 = 28.5% as compared to none in PG No other significant differences were found on indications of episiotomy.Conclusion:Episiotomy is a very common obstetric intervention (51.20%). The PG experience episiotomy significantly more often than G2 and above women. Efforts should be made to reduce its rates. This can be done by reviewing the indications and rates at repeated intervals and setting guidelines for these indications.

Risk of Episiotomy and Perineal Lacerations Recurring After First Delivery

To assess whether the presence of an episiotomy or spontaneous perineal trauma at the first delivery increases the risk of perineal trauma at the following one. We studied 2,695 women who gave birth twice at Virgen de las Nieves University Hospital of Granada, Spain. All second deliveries were from 2004 to 2011 and prenatal database records were used to obtain information about the first deliveries. All births, first and second, were single, vaginal, unassisted, and in a cephalic presentation. Two groups were made as follows: Intact perineum (no perineal trauma or first-degree spontaneous tear at the first delivery) and perineal trauma (episiotomy or second-degree or higher spontaneous tear at the first delivery). Both groups were compared according to the degree of perineal trauma at the second delivery. Women included in the perineal trauma group were significantly older and a higher proportion was attended by a midwife with an obstetrician present in the delivery room. No differences were observed according to gestational age, epidural analgesia or fetal birth weight. Adjusting for these possible compounding factors and the year of birth, the risk of undergoing a second-degree or higher spontaneous tear at their next delivery was fivefold (adjusted OR 5.15, 95% CI 3.11-8.54), and the risk of undergoing an episiotomy in the second delivery was threefold (adjusted OR 3.20, 95% CI 2.19-4.69) for the perineal trauma group. The risk of undergoing a spontaneous perineal tear or an episiotomy in the second delivery is increased by the practice of episiotomy in the first one.

Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery

In Singapore, a developed Asian nation, a relatively high proportion of women undergo episiotomy. We assess risk factors and midwife-reported reasons for episiotomy among women undergoing normal vaginal deliveries (NVDs) conducted by midwives and ascertain the association between episiotomy and degree of perineal tear. Participants included 77 midwives from a high-volume delivery unit in Singapore. The study had three sequential phases: (1) medical record review of women undergoing NVDs conducted by midwives over a 1-month period to document the proportion with episiotomy; (2) focus group discussions with midwives to form a checklist of reasons for episiotomy; (3) checklist-based documentation of midwife-reported reasons for episiotomy and data collection on maternal, neonatal, practice and midwife factors, and degree of perineal tear among women undergoing NVDs conducted by midwives over a 2-month period. Risk factors for episiotomy were assessed through logistic regression. Primiparity, advanced maternal age, Indian ethnicity, higher birth weight and older midwife age were associated with episiotomy. The most common midwife-reported reason for episiotomy among primiparous women was primiparity (55.1%), and among multiparous women was fetal distress (20.0%) and poor maternal effort (20.0%). All women with episiotomy sustained at least a second-degree perineal tear versus 27.1% among women without episiotomy. Most midwife-reported reasons for episiotomy were not congruent with international practice guidelines. Women without episiotomy have lesser tears than those with episiotomy. Practice protocols and educational programs are needed to change episiotomy practice.

What factors influence midwives' decision to perform or avoid episiotomies? A focus group study

Objectiveto explore midwives' reasons for performing or avoiding episiotomies and motivation to change episiotomy practice in a large tertiary maternity hospital. Designusing purposive sampling, three focus groups were conducted to achieve theme saturation. Open-ended questions elicited personal reasons for performing or avoiding episiotomy, information sources, and opinions about past and future practice trends. Sessions were audiotaped, and transcripts independently examined by three researchers who coded for themes. An iterative process was used to achieve consensus. Grounded theory was used to interpret data and to derive a theoretical framework for understanding the reasoning that influences episiotomy practice. Settinga high volume delivery unit in Singapore. Participants20 of 79 licensed midwives, aged 28–70, who performed independent deliveries at the delivery unit. Findingsparticipants recognised maternal, fetal and other factors affecting their own decision to perform episiotomies. Patient request, better healing, midwife's reputation and job satisfaction were cited as main reasons to avoid episiotomy. Key sources informing practice were past training, delivery experience, anecdotal learning and lack of a protocol. There was no consensus on current trends in episiotomy practice. There was an absence of recognition of individual roles in reducing episiotomy rates. Clinicians were perceived as having both positive and negative influence. Conclusionsmidwives' reasons for performing episiotomies were attributed to midwifery training, fear of doing harm and perceived clinician expectation, and were not consistent with current international practice guidelines. Reasons for avoiding episiotomies were associated with patient-centeredness and job satisfaction. Midwives agreed on the need to reduce episiotomy rates. Implications for practicewith reduction in episiotomy rates as a goal, a combination of guideline education, feedback, peer coaching and collaborative care with doctors may be needed to achieve desired outcomes. Views and experiences of midwives should also be incorporated into strategies to change episiotomy practice.

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The practice of episiotomy in a university teaching hospital in Nigeria: How satisfactory?

Background : Episiotomy is essentially a surgical procedure but it is often relegated to the least experienced member of the obstetric team with possible untoward consequences to the mother. Aim : This study set out to appraise how episiotomy was practiced in the University of Calabar Teaching Hospital during the period of the study. Materials and Methods : It was a cross sectional exploratory study which assessed episiotomy and episiorrhaphy procedures among parturients in the centre. Results : Thirty two percent of the 275 parturients studied did not know what episiotomy means. The majority (61.5%) of the parturients were not counseled on the need for episiotomy before the procedure was performed on them. The mean delivery-repair interval for episiotomy among parturients in the study population was 17.9 + 5.66 minutes. Most (75.6%) of the episiotomies were performed by midwives. A significant proportion (45.8%) of the parturients had episiotomy performed on them without prior administration of local anaesthesia. The majority (52.7%) of the episiotomies were repaired by house officers. Common complications among women in the study population were perineal discomfort, perineal pain and difficulty in breastfeeding. Conclusion : The practice of episiotomy in the studied University Teaching Hospital during the period of the study did not meet all necessary requirements of a surgical procedure. Senior members of the obstetric team should supervise the practice in order to ensure the maintenance of standard. Keywords : Episiotomy, episiorrhaphy, surgical procedure, practice, counseling

Current approach to episiotomy: Inevitable or unnecessary?

AbstractAn episiotomy is a surgical incision through the perineum made to provide sufficient area for the delivery of the infant. About 10 to 95% of women who deliver will have episiotomy depending on which part of the world they are having delivery.Too early episiotomy causes extensive bleeding and too late episiotomy causes the excessive stretching of a pelvic floor and lacerations could not be prevented.According to widely accepted arguments, there are many benefits of episiotomy for the neonate: prevention of injuries, shoulder dystocia and mental retardation of the infant. Benefits for the mother are: reduction of severe lacerations, prevention of sexual dysfunction, prevention of urinary and fecal incontinence. But those things could also be complications of episiotomy, if it is being used nonrestrictively. Some other complications are also extensive bleeding, hematoma or infection.There are many different opinions in literature about using episiotomy restrictively or routinely, so it is the right doubt arisen: is it inevitable or unnecessary?There is a wide variation in episiotomy practice, and the decision of performing it or not depends of actual clinical situation.There is still a great need for continuous obstetrics education according to the evidence based guidelines for the patient’s safety.

Incidencia y factores relacionados con la pérdida hemática intraparto excesiva

Introduction Childbirth and postpartum carry a high potential risk to the woman, with bleeding being a major cause of morbidity and mortality. A drop in haemoglobin ≥ 3.5 g during the delivery process is considered as excessive bleeding, and is used as an indicator of quality of care in childbirth. Objective To determine the incidence and factors associated with excessive intrapartum blood loss. Subjects and methods Hybrid design nested case-control study was performed in a cohort of 1488 pregnant women who gave birth at the Hospital La Mancha-Centro in 2008. We selected all the cases (84 subjects with a haemoglobin loss of ≥ 3.5 g) and twice the number of controls (164) matched by time of delivery. Multivariate analysis was performed using conditional logistic regression. Results The incidence of excessive intrapartum bleeding was 6.6%, with no significant differences regarding the mode of delivery (Vaginal and Caesarean = 6.8% = 5.6%). Antepartum anaemia was around 10% and postpartum anaemia 41.4%. We found no factors associated with bleeding in Caesarean deliveries. However, in the vaginal primiparity, manual removal and particularly the practice of episiotomy [OR = 4.82 (95% CI, 1.73 to 13.44] are presented as clear risk factors. Conclusion The incidence of excessive bleeding is above recommended levels. Primiparity, manual removal and particularly episiotomy are risk factors for bleeding.

Morbidité périnéale des extractions instrumentales par spatules et ventouses : qu’en est-il réellement ?

To evaluate the perineal morbidity of operative vaginal delivery using spatulas and vacuum. From December 2008 to May 2010, 419 single pregnancies after 37 weeks of gestation in cephalic position were prospectively included: 226 spontaneous vaginal deliveries and 193 operative vaginal deliveries (126 spatulas and 67 vacuum). Each patient had rigorous clinical examination of the perineum. Perineal tears were classified in four different degrees depending on their severity: injury to skin only or episiotomy, injury to the perineum involving perineal muscles, anal sphincter rupture without and with anal epithelium tear, respectively. The rate of second degree or more perineal tear among patients who had spontaneous vaginal delivery, operative vaginal delivery using spatulas and vacuum was: 5.9%, 27% and 28.6%, respectively (p<0.001). If no significant difference was observed between the rate of perineal damages after spatulas and vacuum, compared to spontaneous vaginal delivery, only spatulas were significantly associated to the risk of third degree or more perineal damage: 2 (0.9%) vs. 6 (5.2%), respectively (p=0.022). Only operative vaginal delivery was identified as an independent risk factor for second degree or more perineal tear (AOR: 4.589; 95%CI: 2.012-10.467; p<0.001). Episiotomy had no independent significant impact on that risk (AOR: 0.690; 95%CI: 0.350-1.359; p=0.283). Operative vaginal delivery using spatulas and vacuum does significantly increase perineal morbidity. This risk appears to be independent of the practice of episiotomy.

The practice of episiotomy: a qualitative descriptive study on perceptions of a group of women

Este estudo teve como objetivo compreender a experiencia e as percepcoes de um grupo de mulheres em relacao a pratica da episiotomia no momento do parto. Trata-se de um estudo qualitativo descritivo, realizado em hospital de ensino de Sao Paulo. Os dados foram coletados por meio de entrevistas semi-estruturadas com a participacao de 35 multiparas, que tiveram partos com e sem episiotomia. A analise permitiu a identificacao das seguintes categorias: Depende do tamanho do bebe, facilita o parto; Depende de cada mulher; A mulher nao fica aberta; e A Episiotomia nao e necessaria. Os relatos mostram que existe falta de esclarecimento e conhecimento em relacao a esta pratica, o que faz com que o papel de decisao acabe nas maos dos profissionais. Conclui-se que e importante no panorama profissional o conhecimento das evidencias cientificas, a conscientizacao vinculada aos direitos das usuarias e o respeito as suas individualidades. Descritores : Episiotomia; Assistencia a Saude; Enfermagem Obstetrica.