Impact of a major decrease in the use of episiotomy on perineal tears in a level III maternity ward [Influence d'une forte diminution du recours à l'épisiotomie sur le taux global de périnée intact et peu lésionnel dans une population d'une maternité de niveau III]

摘要

Objective To evaluate the perineal outcome after a major decrease in episiotomy rate in a high-risk (level III) maternity ward. Materials and methods This was a retrospective cohort study in a teaching high-risk maternity comparing perineal tears between 2003 and 2010. We included for analysis: pregnancies at 25 weeks or more, fetal birthweights of 500 g or more, vaginal deliveries in our maternity, singletons or multiple pregnancies, cephalic or breech presentations. Results The two populations were comparable. In 2003, we performed 18.8% of episiotomies and 1.3% in 2010. Between these years, our intact perineum rate increased from 28.8 to 37.5% (P < 0.0001). We also report an increase in first and second degree perineum lesions (20.5% in 2003 and 40.2% in 2010, P < 0.0001) and anterior perineal lesions (17.8% in 2003 and 30.3% in 2010, P < 0.0001). We also report a significant decrease in perineal lesions with sphincter injuries (1% in 2003 and 0.3% in 2010 P < 0.0001). Discussion Comparing 2003 to 2010, the majority of cases with no episiotomy (over 2/3) resulted in first degree perineum lesions which are today recognized as benign lesions without any systematic need for suturing. A restrictive use of episiotomy increases the rate of intact perineum and of "non-severe" perineal lesions.