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Randomized Controlled Trial
. 2008 Jan;115(2):247-52.
doi: 10.1111/j.1471-0528.2007.01540.x. Epub 2007 Oct 25.

Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy

X Fritel  1 , J P Schaal, A Fauconnier, V Bertrand, C Levet, A Pigné
Affiliations
Randomized Controlled Trial

Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy

X Fritel et al. BJOG. 2008 Jan.

Abstract

Objective: To compare two policies for episiotomy: restrictive and systematic.

Design: Quasi-randomised comparative study.

Setting: Two French university hospitals with contrasting policies for episiotomy: one using episiotomy restrictively and the second routinely.

Population: Seven hundred and seventy-four nulliparous women delivered during 1996 of a singleton in cephalic presentation at a term of 37-41 weeks.

Methods: A questionnaire was mailed 4 years after delivery. Sample size was calculated to allow us to show a 10% difference in the prevalence of urinary incontinence with 80% power.

Main outcome measures: Urinary incontinence, anal incontinence, perineal pain, and pain during intercourse.

Results: We received 627 responses (81%), 320 from women delivered under the restrictive policy, 307 from women delivered under the routine policy. In the restrictive group, 186 (49%) deliveries included mediolateral episiotomies and in the routine group, 348 (88%). Four years after the first delivery, there was no difference in the prevalence of urinary incontinence (26 versus 32%), perineal pain (6 versus 8%), or pain during intercourse (18 versus 21%) between the two groups. Anal incontinence was less prevalent in the restrictive group (11 versus 16%). The difference was significant for flatus (8 versus 13%) but not for faecal incontinence (3% for both groups). Logistic regression confirmed that a policy of routine episiotomy was associated with a risk of anal incontinence nearly twice as high as the risk associated with a restrictive policy (OR = 1.84, 95% CI: 1.05-3.22).

Conclusions: A policy of routine episiotomy does not protect against urinary or anal incontinence 4 years after first delivery.

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References

    1. Graham ID, Carroli G, Davies C, Medves JM. Episiotomy rates around the world: an update. Birth. 2005;32:219–23. - PubMed
    1. Alran S, Sibony O, Oury JF, Luton D, Blot P. Differences in management and results in term-delivery in nine European referral hospitals: descriptive study. Eur J Obstet Gynecol Reprod Biol. 2002;103:4–13. - PubMed
    1. Webb DA, Culhane J. Hospital variation in episiotomy use and the risk of perineal trauma during childbirth. Birth. 2002;29:132–6. - PubMed
    1. Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P. The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing. Br J Urol. 1996;77:805–12. - PubMed
    1. Sandvik H, Seim A, Vanvik A, Hunskaar S, Sandvik A. Severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. Neurourol Urodyn. 2000;19:137–145. - PubMed

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