The practice of episiotomy in public hospitals in Hong Kong. (17/75)

OBJECTIVE: To review the use of episiotomy during vaginal delivery in Hong Kong public hospitals. DESIGN: Prospective observational survey. SETTING: Public hospitals, Hong Kong. PARTICIPANTS: Women who underwent normal vaginal delivery of a singleton foetus with cephalic presentation. MAIN OUTCOME MEASURES: Number of women having an episiotomy, severe-degree (third- or fourth-degree) tear, other types of tear, blood loss at delivery, postpartum haemorrhage, need for blood transfusion, puerperal pyrexia, wound infection, gaping wound that required suture removal, and drainage or resuturing of a perineal wound. RESULTS: Between 1 January and 31 March 2003, there were 6222 singleton spontaneous normal vaginal deliveries in the public hospitals of Hong Kong. Of the 6167 women in whom the status of the perineum was known, episiotomy was performed in 5274 (85.5%). Primiparous women were more likely to undergo episiotomy at delivery than multiparous women (97.9% vs 71.4%). Women with episiotomy had significantly less perineal tearing of any kind than those without. The occurrence of any type of perineal tear and severe-degree (third- or fourth-degree) tear was significantly lower in primiparous women who had an episiotomy than those without (P<0.05). Women with episiotomy had increased mean blood loss at delivery but other complications were not significantly increased. CONCLUSIONS: In Hong Kong, episiotomy is routinely performed during normal vaginal delivery. It is associated with a significantly lower overall rate of perineal tearing. This study was observational, nonetheless the occurrence of other complications was likely to increase when episiotomy was performed. Firm evidence from several randomised controlled studies shows that routine episiotomy is unjustified and possibly harmful. Routine episiotomy should not be promoted in Hong Kong without further randomised controlled study.  (+info)

Demographic variations and clinical associations of episiotomy and severe perineal lacerations in vaginal delivery. (18/75)

Primiparity, birthweight, operative delivery and obstetrical complications contribute to episiotomy and severe perineal lacerations. Episiotomy correlates with Hispanics, while African Americans correlate with severe perineal lacerations. OBJECTIVE: The purpose of this study was to identify risk factors for both episiotomy and severe perineal lacerations in a large population from a single institution. STUDY DESIGN: This was a review of 66,224 vaginal deliveries of African Americans or Hispanics delivering between 25-44 gestational weeks between 1981-2001. Univariate and multiple regression analysis were done as indicated. RESULTS: Independent predictors of episiotomy were: primiparity eight-fold, forceps delivery seven-fold, vacuum delivery five-fold, shoulder dystocia 3.6-fold, macrosomia 1.8-fold, epidural analgesia 1.6-fold, postdates 1.5-fold, Hispanics 1.4-fold. Independent predictors of severe perineal lacerations were; macrosomia seven-fold, episiotomy 4.5-fold, primiparity 4.4-fold, shoulder dystocia 3.6-fold, average birthweight 3.5-fold, forceps delivery 2.6-fold, vacuum delivery two-fold, epidural analgesia two-fold, African-American 1.5-fold. Nonreassuring fetal heart rate patterns, meconium and cord accidents appeared protective. CONCLUSION: Primiparous women with larger babies undergoing operative delivery with epidural analgesia are at risk for both episiotomy incisions and severe perineal lacerations. Though Hispanics are more likely to have an episiotomy, they are at significantly less risk for severe perineal lacerations compared to African Americans. Even though episiotomy is independently associated with severe perineal laceration, other factors such as macrosomia and primiparity are as important.  (+info)

Promoting childbirth companions in South Africa: a randomised pilot study. (19/75)

BACKGROUND: Most women delivering in South African State Maternity Hospitals do not have a childbirth companion; in addition, the quality of care could be better, and at times women are treated inhumanely. We piloted a multi-faceted intervention to encourage uptake of childbirth companions in state hospitals, and hypothesised that lay carers would improve the behaviour of health professionals. METHODS: We conducted a pilot randomised controlled trial of an intervention to promote childbirth companions in hospital deliveries. We promoted evidence-based information for maternity staff at 10 hospitals through access to the World Health Organization Reproductive Health Library (RHL), computer hardware and training to all ten hospitals. We surveyed 200 women at each site, measuring companionship, and indicators of good obstetric practice and humanity of care. Five hospitals were then randomly allocated to receive an educational intervention to promote childbirth companions, and we surveyed all hospitals again at eight months through a repeat survey of postnatal women. Changes in median values between intervention and control hospitals were examined. RESULTS: At baseline, the majority of hospitals did not allow a companion, or access to food or fluids. A third of women were given an episiotomy. Some women were shouted at (17.7%, N = 2085), and a few reported being slapped or struck (4.3%, N = 2080). Despite an initial positive response from staff to the childbirth companion intervention, we detected no difference between intervention and control hospitals in relation to whether a companion was allowed by nursing staff, good obstetric practice or humanity of care. CONCLUSION: The quality and humanity of care in these state hospitals needs to improve. Introducing childbirth companions was more difficult than we anticipated, particularly in under-resourced health care systems with frequent staff changes. We were unable to determine whether the presence of a lay carer impacted on the humanity of care provided by health professionals. TRIAL REGISTRATION: Current Controlled Trials ISRCTN33728802.  (+info)

Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy. (20/75)

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.  (+info)

Trends in major modifiable risk factors for severe perineal trauma, 1996-2006. (21/75)

 (+info)

A behavioral intervention to improve obstetrical care. (22/75)

 (+info)

Randomized controlled clinical trial on two perineal trauma suture techniques in normal delivery. (23/75)

The aim was to compare healing and perineal pain with the use of continuous and interrupted suture techniques in women after normal delivery. A randomized controlled trial was carried out at a hospital birth center in Itapecirica da Serra, Sao Paulo, Brazil. A total of 61 women participated with episiotomy or second degree perineal tear, allocated in two groups according to the continuous (n=31) or interrupted (n=30) suture techniques. The main outcomes evaluated were edema, ecchymosis, hyperemia, secretion, dehiscence, fibrosis, frequency and degree of pain (evaluated by numerical scale from 1 to 10). Data were collected during hospitalization and after discharge (four and 41 days after birth). Healing occurred by first intention in 100% of cases in both suture techniques. There were no statistically significant differences for the occurrence of morbidities, except for perineal pain due to palpation at four days after delivery, which was more frequent among women with interrupted suture.  (+info)

Risk factors for birth canal lacerations in primiparous women. (24/75)

Lacerations of the birth canal are common side effects of vaginal birth. They are potentially preventable. Although serious long-term consequences have been identified for severe perineal lacerations, less attention has been paid to lacerations in other locations and how the risk factors vary for different lacerations. We analyzed a dataset including 1009 primiparous women with singleton pregnancies and vaginal deliveries, and we examined risk factors for third- and fourth-degree perineal lacerations and periurethral, vaginal, and labial lacerations using logistic regression analysis. Large fetal size (> or = 3500 g) substantially increased the risk of perineal (odd ratio [OR], 3.8; 95% confidence interval [CI], 1.8 to 7.9) and periurethral (OR, 2.3; 95% CI, 1.0 to 5.0) lacerations but not other types of lacerations. Episiotomy had no impact on perineal lacerations (OR 0.9) but had very strong protective effects for other lacerations (OR 0.1). Prolonged second stage of labor (> 120 minutes) increased the risk of perineal and vaginal lacerations but reduced the risk for periurethral lacerations. Instrumental deliveries were significant risk factors for third- and fourth-degree perineal lacerations, with by far the strongest effect for low forceps (OR 25.0 versus < 3 for outlet forceps, outlet vacuum, and low vacuum). We concluded that separating different birth canal lacerations is critical in identifying risk factors and potential preventive strategies.  (+info)