British journal of obstetrics and gynaecology · 1994
Episiotomies and the occurrence of severe perineal lacerations.
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Anthony S, Buitendijk S E, Zondervan K T, van Rijssel E J, Verkerk P H
Аннотация
OBJECTIVE: To investigate the relation between the use of mediolateral episiotomy and the occurrence of severe (third degree) perineal tears in hospital deliveries in the Netherlands.
DESIGN: An observational study.
SUBJECTS: Data were derived from the Dutch National Obstetric Database (LVR) of 1990, from which 43,309 spontaneous, occipito-anterior, vaginal deliveries of live, singleton infants were investigated.
INTERVENTION: Medio-lateral episiotomy.
MAIN OUTCOME MEASURE: The occurrence of severe perineal tears.
RESULTS: The severe tear rate was 1.4% in the total study group. Using multiple logistic regression to control for possible confounding variables, the use of mediolateral episiotomy was found to be associated with a more than fourfold decrease in risk of severe lacerations (odds ratio 0.22, 95% CI 0.17 to 0.29). Further, in a logistic model deliveries in hospitals with restrictive use of episiotomy (< 11%) were compared with those in hospitals with liberal use of episiotomy (> 50%). Liberal use of episiotomy was not associated with a lower frequency of severe perineal tears.
CONCLUSION: Although a protective effect of mediolateral episiotomy on the occurrence of severe lacerations was found, liberal use of mediolateral episiotomy should be discouraged on the basis of our findings.
DESIGN: An observational study.
SUBJECTS: Data were derived from the Dutch National Obstetric Database (LVR) of 1990, from which 43,309 spontaneous, occipito-anterior, vaginal deliveries of live, singleton infants were investigated.
INTERVENTION: Medio-lateral episiotomy.
MAIN OUTCOME MEASURE: The occurrence of severe perineal tears.
RESULTS: The severe tear rate was 1.4% in the total study group. Using multiple logistic regression to control for possible confounding variables, the use of mediolateral episiotomy was found to be associated with a more than fourfold decrease in risk of severe lacerations (odds ratio 0.22, 95% CI 0.17 to 0.29). Further, in a logistic model deliveries in hospitals with restrictive use of episiotomy (< 11%) were compared with those in hospitals with liberal use of episiotomy (> 50%). Liberal use of episiotomy was not associated with a lower frequency of severe perineal tears.
CONCLUSION: Although a protective effect of mediolateral episiotomy on the occurrence of severe lacerations was found, liberal use of mediolateral episiotomy should be discouraged on the basis of our findings.