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Database - Alliance francophone pour l'accouchement respecté (AFAR)
Created on : 12/06/2004
Modified on : 2/12/2007

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Author(s) :

Dannecker C, Hillemanns P, Strauss A, Hasbargen U, Hepp H, Anthuber C.

Bibliographical entry (without author) :

Episiotomy and perineal tears presumed to be imminent: randomized controlled trial.
Acta Obstet Gynecol Scand. 2004 Apr;83(4):364-8.

Year of publication :


Résumé (français) :

Abstract (English):

BACKGROUND: The indication of the restricted use of episiotomy at tears presumed to be imminent is not clear.

METHODS: Randomized controlled trial with two perineal management policies. Use of episiotomy: (a). only for fetal indications and (b). in addition at a tear presumed to be imminent. Participants: 146 primiparous women with an uncomplicated singleton pregnancy at >34 weeks of gestation. For the intention-to-treat analysis those 109 women were included who vaginally delivered a live full-term baby between January 1999 and September 2000: 49 women in group a, 60 in group b.

OUTCOME MEASURES: Reduction of episiotomies, increase of intact perinea or only minor perineal trauma (intact perineum and first-degree tears), third-degree tears, anterior perineal trauma, perineal pain in the postpartum period, pH of the umbilical artery, Apgar scores, maternal blood loss.

RESULTS: Episiotomy rates were 41% in group a and 77% in group b (p < 0.001). Women in the restrictive policy group had a greater chance of an intact perineum (29% vs. 10%; p = 0.023) or only minor perineal trauma (39% vs. 13%; p = 0.003) and had significant lower pain scores postpartum at different activities. There were no statistically significant differences with regard to third-degree tears, anterior trauma, pre- and postpartum hemoglobin concentrations, Apgar scores and pH of the umbilical artery.

CONCLUSIONS: Avoiding episiotomy at tears presumed to be imminent increases the rate of intact perinea and the rate of only minor perineal trauma, reduces postpartum perineal pain and does not have any adverse effects on maternal or fetal morbidity.

Sumário (português):


Full text (private) :

Comments :

Le taux de 41% d'épisiotomies dans le groupe (a) est à peu de choses près la moyenne nationale en Allemagne à l'époque de cette étude.

Argument (français) :

Le fait d'éviter de pratiquer une épisiotomie sur un périnée "prêt à se rompre" augmente le taux de périnées intacts, celui des petits traumatismes périnéaux, diminue la douleur post-partum, sans effet adverse sur la morbidité maternelle ou foetale.

Argument (English):

Avoiding episiotomy at tears presumed to be imminent increases the rate of intact perinea...

Argumento (português):

Keywords :

perineal/vaginal tears ; fetal distress ; episiotomy ; evidence-based medicine/midwifery ; morbidity

Author of this record :

Cécile_Loup — 12/06/2004

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