Journal of Gynecology and Obstetrics

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Restriction of Episiotomy: Obstetrical Indications and Perineal Prognosis in Two Maternity Wards in Brazzaville (Republic of Congo)

Received: 18 October 2020    Accepted: 28 October 2020    Published: 09 November 2020
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Abstract

Objective: In December 2018, new recommendations from the National College of French Obstetrician Gynaecologists restricted obstetric indications for episiotomy to only instrumental delivery, to avoid the occurrence of obstetric lesions of the anus sphincter. In our maternity wards, episiotomy is still performed liberally in the face of high-risk perineal situations, without significant reduction in perineal tears. This is how the present study set itself the objective of evaluating the impact of a restrictive practice of episiotomy on the perineum. Methods: Before-after non-experimental evaluative study, conducted from March 1 to August 30, 2019, in two maternity hospitals in Brazzaville, comparing according to a 1/1 ratio, after matching age and parity, 300 parturient with a high situation perineal risk of episiotomy having benefited from a procedure restricting episiotomy to 300 others who did not benefit. The two groups were evaluated: the percentage of episiotomy, the percentage, and the degree of perineal tears. The effect of the restriction was assessed by calculations of the difference in absolute risk (DR), reduction in relative risk (RRR) and the number of subjects required to treat (NST). Results: Parturient with high perineal risk had a median age of 23 years (18-28) and were primiparous (0-1.5). The high perineal risk situations were dominated in the two groups by the maternal indications concerning parity (nulliparity: 40% vs 63%) and the perineum (scar: 51% vs 60%); followed by macrosomia (25% vs 38%) and prematurity (25% vs 16%) as fetal indications. The episiotomy was performed in all cases of instrumental forceps extraction (1.3% vs 5%). The restrictive practice of episiotomy was effective in 96% of cases with 69.8% of intact perineum vs 19%. It had a protective effect on the perineum, making it possible to avoid the occurrence of 82 episiotomies (DR=-82% [-93, -70]; RRR=95%) and 50 perineal tears (DR=-50% [-66, -34]; RRR=63%) for 100 parturient. To avoid an episiotomy and a perineal tear, the restriction procedure must be applied to an average of 1.2 parturient (NST=-1.2) and two parturient (NST=-2), respectively. Conclusion: It is entirely possible to opt for a restrictive practice of episiotomy in our maternities by rigorously and meticulously evaluating the perineal risks and by respecting the procedures for protecting the perineum during childbirth.

DOI 10.11648/j.jgo.20200806.14
Published in Journal of Gynecology and Obstetrics (Volume 8, Issue 6, November 2020)
Page(s) 174-178
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Episiotomy, Restriction, Impact, Childbirth, Brazzaville

References
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[2] Venditelli F, Gallot D (2006) Quelles sont les données épidémiologiques concernant l’épisiotomie ? J Gynecol Obstet Biol Reprod 35: 12–23.
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[6] Ducarme G, Pizzoferrato AC, De Tayrac R (2018) Prévention et protection périnéale en obstétrique : Recommandations pour la Pratique Clinique du CNGOF. Gynecol Obstet Fertil Senol 46: 893–99.
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Author Information
  • Obstetrics Gynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo

  • Obstetrics Gynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo

  • Obstetrics GFaculty of Health Sciences, Marien NGOUABI University, Brazzaville, Congoynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo;

  • Obstetrics GFaculty of Health Sciences, Marien NGOUABI University, Brazzaville, Congoynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo;

  • Obstetrics GFaculty of Health Sciences, Marien NGOUABI University, Brazzaville, Congoynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo;

  • Obstetrics GFaculty of Health Sciences, Marien NGOUABI University, Brazzaville, Congoynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo;

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  • APA Style

    Buambo Gauthier Regis Jostin, Ele Elenga Varel Pirnet, Potokoue Mpia Samantha Nuelly, Mokoko Jules Cesar, Itoua Clautaire, et al. (2020). Restriction of Episiotomy: Obstetrical Indications and Perineal Prognosis in Two Maternity Wards in Brazzaville (Republic of Congo). Journal of Gynecology and Obstetrics, 8(6), 174-178. https://doi.org/10.11648/j.jgo.20200806.14

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    ACS Style

    Buambo Gauthier Regis Jostin; Ele Elenga Varel Pirnet; Potokoue Mpia Samantha Nuelly; Mokoko Jules Cesar; Itoua Clautaire, et al. Restriction of Episiotomy: Obstetrical Indications and Perineal Prognosis in Two Maternity Wards in Brazzaville (Republic of Congo). J. Gynecol. Obstet. 2020, 8(6), 174-178. doi: 10.11648/j.jgo.20200806.14

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    AMA Style

    Buambo Gauthier Regis Jostin, Ele Elenga Varel Pirnet, Potokoue Mpia Samantha Nuelly, Mokoko Jules Cesar, Itoua Clautaire, et al. Restriction of Episiotomy: Obstetrical Indications and Perineal Prognosis in Two Maternity Wards in Brazzaville (Republic of Congo). J Gynecol Obstet. 2020;8(6):174-178. doi: 10.11648/j.jgo.20200806.14

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  • @article{10.11648/j.jgo.20200806.14,
      author = {Buambo Gauthier Regis Jostin and Ele Elenga Varel Pirnet and Potokoue Mpia Samantha Nuelly and Mokoko Jules Cesar and Itoua Clautaire and Iloki Leon Herve},
      title = {Restriction of Episiotomy: Obstetrical Indications and Perineal Prognosis in Two Maternity Wards in Brazzaville (Republic of Congo)},
      journal = {Journal of Gynecology and Obstetrics},
      volume = {8},
      number = {6},
      pages = {174-178},
      doi = {10.11648/j.jgo.20200806.14},
      url = {https://doi.org/10.11648/j.jgo.20200806.14},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.jgo.20200806.14},
      abstract = {Objective: In December 2018, new recommendations from the National College of French Obstetrician Gynaecologists restricted obstetric indications for episiotomy to only instrumental delivery, to avoid the occurrence of obstetric lesions of the anus sphincter. In our maternity wards, episiotomy is still performed liberally in the face of high-risk perineal situations, without significant reduction in perineal tears. This is how the present study set itself the objective of evaluating the impact of a restrictive practice of episiotomy on the perineum. Methods: Before-after non-experimental evaluative study, conducted from March 1 to August 30, 2019, in two maternity hospitals in Brazzaville, comparing according to a 1/1 ratio, after matching age and parity, 300 parturient with a high situation perineal risk of episiotomy having benefited from a procedure restricting episiotomy to 300 others who did not benefit. The two groups were evaluated: the percentage of episiotomy, the percentage, and the degree of perineal tears. The effect of the restriction was assessed by calculations of the difference in absolute risk (DR), reduction in relative risk (RRR) and the number of subjects required to treat (NST). Results: Parturient with high perineal risk had a median age of 23 years (18-28) and were primiparous (0-1.5). The high perineal risk situations were dominated in the two groups by the maternal indications concerning parity (nulliparity: 40% vs 63%) and the perineum (scar: 51% vs 60%); followed by macrosomia (25% vs 38%) and prematurity (25% vs 16%) as fetal indications. The episiotomy was performed in all cases of instrumental forceps extraction (1.3% vs 5%). The restrictive practice of episiotomy was effective in 96% of cases with 69.8% of intact perineum vs 19%. It had a protective effect on the perineum, making it possible to avoid the occurrence of 82 episiotomies (DR=-82% [-93, -70]; RRR=95%) and 50 perineal tears (DR=-50% [-66, -34]; RRR=63%) for 100 parturient. To avoid an episiotomy and a perineal tear, the restriction procedure must be applied to an average of 1.2 parturient (NST=-1.2) and two parturient (NST=-2), respectively. Conclusion: It is entirely possible to opt for a restrictive practice of episiotomy in our maternities by rigorously and meticulously evaluating the perineal risks and by respecting the procedures for protecting the perineum during childbirth.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Restriction of Episiotomy: Obstetrical Indications and Perineal Prognosis in Two Maternity Wards in Brazzaville (Republic of Congo)
    AU  - Buambo Gauthier Regis Jostin
    AU  - Ele Elenga Varel Pirnet
    AU  - Potokoue Mpia Samantha Nuelly
    AU  - Mokoko Jules Cesar
    AU  - Itoua Clautaire
    AU  - Iloki Leon Herve
    Y1  - 2020/11/09
    PY  - 2020
    N1  - https://doi.org/10.11648/j.jgo.20200806.14
    DO  - 10.11648/j.jgo.20200806.14
    T2  - Journal of Gynecology and Obstetrics
    JF  - Journal of Gynecology and Obstetrics
    JO  - Journal of Gynecology and Obstetrics
    SP  - 174
    EP  - 178
    PB  - Science Publishing Group
    SN  - 2376-7820
    UR  - https://doi.org/10.11648/j.jgo.20200806.14
    AB  - Objective: In December 2018, new recommendations from the National College of French Obstetrician Gynaecologists restricted obstetric indications for episiotomy to only instrumental delivery, to avoid the occurrence of obstetric lesions of the anus sphincter. In our maternity wards, episiotomy is still performed liberally in the face of high-risk perineal situations, without significant reduction in perineal tears. This is how the present study set itself the objective of evaluating the impact of a restrictive practice of episiotomy on the perineum. Methods: Before-after non-experimental evaluative study, conducted from March 1 to August 30, 2019, in two maternity hospitals in Brazzaville, comparing according to a 1/1 ratio, after matching age and parity, 300 parturient with a high situation perineal risk of episiotomy having benefited from a procedure restricting episiotomy to 300 others who did not benefit. The two groups were evaluated: the percentage of episiotomy, the percentage, and the degree of perineal tears. The effect of the restriction was assessed by calculations of the difference in absolute risk (DR), reduction in relative risk (RRR) and the number of subjects required to treat (NST). Results: Parturient with high perineal risk had a median age of 23 years (18-28) and were primiparous (0-1.5). The high perineal risk situations were dominated in the two groups by the maternal indications concerning parity (nulliparity: 40% vs 63%) and the perineum (scar: 51% vs 60%); followed by macrosomia (25% vs 38%) and prematurity (25% vs 16%) as fetal indications. The episiotomy was performed in all cases of instrumental forceps extraction (1.3% vs 5%). The restrictive practice of episiotomy was effective in 96% of cases with 69.8% of intact perineum vs 19%. It had a protective effect on the perineum, making it possible to avoid the occurrence of 82 episiotomies (DR=-82% [-93, -70]; RRR=95%) and 50 perineal tears (DR=-50% [-66, -34]; RRR=63%) for 100 parturient. To avoid an episiotomy and a perineal tear, the restriction procedure must be applied to an average of 1.2 parturient (NST=-1.2) and two parturient (NST=-2), respectively. Conclusion: It is entirely possible to opt for a restrictive practice of episiotomy in our maternities by rigorously and meticulously evaluating the perineal risks and by respecting the procedures for protecting the perineum during childbirth.
    VL  - 8
    IS  - 6
    ER  - 

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