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

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 sev...

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Bibliographic Details
Published in:BJOG : an international journal of obstetrics and gynaecology 2008-01, Vol.115 (2), p.247-252
Main Authors: Fritel, X, Schaal, JP, Fauconnier, A, Bertrand, V, Levet, C, Pigné, A
Format: Article
Language:English
Subjects:
Adult
Anal incontinence
Biological and medical sciences
Childbirth & labor
Comparative studies
delivery
Delivery. Postpartum. Lactation
Dyspareunia
Dyspareunia - etiology
Episiotomy
Episiotomy - adverse effects
Episiotomy - methods
Fecal Incontinence
Fecal Incontinence - etiology
Female
Female Urogenital Diseases
Female Urogenital Diseases - etiology
Flatulence
Flatulence - etiology
Gynecology and obstetrics
Gynecology. Andrology. Obstetrics
Human health and pathology
Humans
Life Sciences
Medical sciences
Nephrology. Urinary tract diseases
Obstetric Labor Complications
Obstetric Labor Complications - surgery
Obstetrics
Organizational Policy
Pain
Pain - etiology
Pelvic Floor
perineal pain
Pregnancy
Questionnaires
Risk Factors
Side effects
Urinary Incontinence
Urinary Incontinence - etiology
Urinary system involvement in other diseases. Miscellaneous
Urinary tract. Prostate gland
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Summary: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.
ISSN:1470-0328
1471-0528
DOI:10.1111/j.1471-0528.2007.01540.x