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7 results on '"MESH: Obstetric Labor Complications"'

1. Kleine-Levin syndrome is associated with birth difficulties and genetic variants in the TRANK1 gene loci

Author

Natan Gadoth, Birgit Högl, Rosa Hasan, G. Plazzi, Andrea N. Goldstein-Piekarski, Makrina Daniilidou, Thomas J Rico, Smaranda Leu-Semenescu, Ryan P. Hillary, Neal M. Farber, Guy D. Leschziner, Emmanuel Mignot, Yakov Sivan, Michel Lecendreux, José L. Vicario, Hanna Ollila, Juliette Faraco, Sona Nevsimalova, Isabelle Arnulf, Fang Han, Francesca Canellas, Pauline Dodet, Patrice Bourgin, Geert Mayer, Fabio Pizza, Makoto Honda, Yu-Shu Huang, Kazuhiko Kume, Rosa Peraita-Adrados, Ling Lin, David B. Rye, Takashi Kanbayashi, Eileen B. Leary, Seung Chul Hong, Emmanuel H. During, Anne-Marie Landtblom, Yves Dauvilliers, Aditya Ambati, Ambati A., Hillary R., Leu-Semenescu S., Ollila H.M., Lin L., During E.H., Farber N., Rico T.J., Faraco J., Leary E., Goldstein-Piekarski A.N., Huang Y.-S., Han F., Sivan Y., Lecendreux M., Dodet P., Honda M., Gadoth N., Nevsimalova S., Pizza F., Kanbayashi T., Peraita-Adrados R., Leschziner G.D., Hasan R., Canellas F., Kume K., Daniilidou M., Bourgin P., Rye D., Vicario J.L., Hogl B., Hong S.C., Plazzi G., Mayer G., Landtblom A.M., Dauvilliers Y., Arnulf I., Mignot E.J.-M., Retiveau, Nolwenn, Stanford University, Service de Pathologies du sommeil [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre National de Référence pour les Maladies Rares : narcolepsie, hypersomnie idiopathique et syndrome de Kleine-Levin [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Veterans Affairs Palo Alto Healthcare System, Chang Gung Memorial Hospital [Taipei] (CGMH), Peking University [Beijing], Sackler Faculty of Medicine, Tel Aviv University (TAU), Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), Tokyo Metropolitan Institute of Medical Science (TMIMS), Tel Aviv Sourasky Medical Center [Te Aviv], Charles University [Prague] (CU), University of Bologna/Università di Bologna, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Université de Tsukuba = University of Tsukuba, Hospital General Universitario 'Gregorio Marañón' [Madrid], Guy's Hospital [London], King‘s College London, Universidade de São Paulo = University of São Paulo (USP), Nagoya City University [Nagoya, Japan], Uppsala University Hospital, Linköping university hospital, CHU Strasbourg, Emory University [Atlanta, GA], Innsbruck Medical University = Medizinische Universität Innsbruck (IMU), Catholic University of Korea, Philipps Universität Marburg = Philipps University of Marburg, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut des Neurosciences de Montpellier (INM), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)

Subjects
Male, Pediatrics, Bipolar Disorder, [SDV]Life Sciences [q-bio], Genome-wide association study, MESH: Risk Assessment, MESH: Pregnancy, MESH: Risk Factors, Pregnancy, MESH: Bipolar Disorder, Birth difficultie, Odds Ratio, GWAS, Apathy, MESH: Genetic Variation, Obstetric Labor Complication, MESH: Genetic Association Studies, MESH: Cytokines, Hypersomnia, Multidisciplinary, MESH: Genetic Predisposition to Disease, Pathophysiology, [SDV] Life Sciences [q-bio], Schizophrenia, Female, Disease Susceptibility, medicine.symptom, MESH: Kleine-Levin Syndrome, Human, medicine.medical_specialty, MESH: Obstetric Labor Complications, MESH: Disease Susceptibility, Birth difficulties, Disorders of Excessive Somnolence, Genetic Association Studie, Kleine-Levin Syndrome, Risk Assessment, MESH: Polymorphism, Genetic, medicine, Genetic Predisposition to Disease, Bipolar disorder, Cytokine, MESH: Humans, Polymorphism, Genetic, business.industry, Risk Factor, Genetic Variation, Odds ratio, medicine.disease, MESH: Male, MESH: Odds Ratio, Kleine–Levin syndrome, Kleine-Levin syndrome, bipolar disorder, birth difficulties, hypersomnia, Disinhibition, business, MESH: Female, MESH: Disorders of Excessive Somnolence
Abstract

Kleine-Levin syndrome (KLS) is a rare disorder characterized by severe episodic hypersomnia, with cognitive impairment accompanied by apathy or disinhibition. Pathophysiology is unknown, although imaging studies indicate decreased activity in hypothalamic/thalamic areas during episodes. Familial occurrence is increased, and risk is associated with reports of a difficult birth. We conducted a worldwide case.control genome-wide association study in 673 KLS cases collected over 14 y, and ethnically matched 15,341 control individuals. We found a strong genome-wide significant association (rs71947865, Odds Ratio [OR] = 1.48, P = 8.6 × 10-9) within the 3'region of TRANK1 gene locus, previously associated with bipolar disorder and schizophrenia. Strikingly, KLS cases with rs71947865 variant had significantly increased reports of a difficult birth. As perinatal outcomes have dramatically improved over the last 40 y, we further stratified our sample by birth years and found that recent cases had a significantly reduced rs71947865 association. While the rs71947865 association did not replicate in the entire follow-up sample of 171 KLS cases, rs71947865 was significantly associated with KLS in the subset follow-up sample of 59 KLS cases who reported birth difficulties (OR = 1.54, P = 0.01). Genetic liability of KLS as explained by polygenic risk scores was increased (pseudo R2= 0.15; P < 2.0 ∼ 10-22at P = 0.5 threshold) in the follow-up sample. Pathway analysis of genetic associations identified enrichment of circadian regulation pathway genes in KLS cases. Our results suggest links between KLS, circadian regulation, and bipolar disorder, and indicate that the TRANK1 polymorphisms in conjunction with reported birth difficulties may predispose to KLS.

Published
2021
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2. Current evidence supporting obstetric fistula prevention strategies in sub Saharan Africa: a systematic review of the literature

Author

Banke-Thomas, AO, Wilton-Waddell, OE, Kouraogo, SF, Mueller, JE, EHESP, SCD, École des Hautes Études en Santé Publique [EHESP] (EHESP), Département Méthodes quantitatives en santé publique (METIS), and Institut Pasteur [Paris]

Subjects
MESH: Health Services Needs and Demand, Obstetric fistula, Fistula prevention, Prevention strategies, Sub-Saharan Africa, MESH: Socioeconomic Factors, Health Services Needs and Demand, MESH: Humans, MESH: Obstetric Labor Complications, Vaginal Fistula, Obstetric Labor Complications, MESH: Pregnancy, Socioeconomic Factors, MESH: Risk Factors, Pregnancy, Risk Factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Vaginal Fistula, MESH: Preventive Health Services, Preventive Health Services, MESH: Maternal Health Services, Humans, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, Maternal Health Services, MESH: Africa South of the Sahara, MESH: Female, Africa South of the Sahara
Abstract

Obstetric fistula has been eliminated in developed countries, but remains highly prevalent in sub-Saharan Africa. The End fistula campaign is the first concerted effort to eradicate the disease. The objective of this review is to retrieve and link available evidence to obstetric fistula prevention strategies in sub-Saharan Africa, since the campaign began. We searched databases for original research on obstetric fistula prevention. Fifteen articles meeting inclusion criteria were assessed for quality, and data extraction was performed. Grey literature provided context. Evidences from the articles were linked to prevention strategies retrieved from grey literature. The strategies were classified using an innovative target-focused method. Gaps in the literature show the need for fistula prevention research to aim at systematically measuring incidence and prevalence of the disease, identify the most effective and cost-effective strategies for fistula prevention and utilise innovative tools to measure impact of strategies in order to ensure eradication of fistula. (Afr J Reprod Health 2014; 18[3]: 118-127)Keywords: Obstetric fistula; Fistula prevention; Prevention strategies; Sub-Saharan Africa

Published
2014

3. Is prenatal identification of fetal macrosomia useful?

Author

Vendittelli , Françoise, Rivière , Olivier, Bréart , Gérard, Renseigné , Non, Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement ( PEPRADE ), CHU Clermont-Ferrand-Université d'Auvergne - Clermont-Ferrand I ( UdA ), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants ( UMR_S 953 ), Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement (PEPRADE), CHU Clermont-Ferrand-Université d'Auvergne - Clermont-Ferrand I (UdA), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris-Sud - Paris 11 (UP11), and Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Pediatrics, Neonatal intensive care unit, MESH : Intensive Care, Neonatal, Perineum, MESH : Obstetric Labor Complications, Fetal Macrosomia, Cohort Studies, 0302 clinical medicine, MESH: Pregnancy, Pregnancy, Prenatal Diagnosis, Odds Ratio, Birth Weight, MESH : Apgar Score, MESH : Female, 030212 general & internal medicine, MESH: Cohort Studies, 030219 obstetrics & reproductive medicine, MESH: Infant, Newborn, Obstetrics and Gynecology, MESH: Cesarean Section, MESH : Adult, 3. Good health, [ SDV.BDLR ] Life Sciences [q-bio]/Reproductive Biology, MESH: Young Adult, Female, Apgar score, France, MESH : Resuscitation, MESH: Resuscitation, Cohort study, Adult, medicine.medical_specialty, MESH: Obstetric Labor Complications, Resuscitation, Birth weight, MESH : Young Adult, MESH : Cohort Studies, MESH : Perineum, MESH : Infant, Newborn, Young Adult, 03 medical and health sciences, MESH : Cesarean Section, Intensive care, medicine, Fetal macrosomia, Humans, MESH: Prenatal Diagnosis, MESH: Birth Weight, MESH: Perineum, MESH : France, MESH : Prenatal Diagnosis, MESH: Humans, Cesarean Section, business.industry, MESH : Humans, Infant, Newborn, MESH: Adult, [SDV.BDLR]Life Sciences [q-bio]/Reproductive Biology, MESH : Birth Weight, medicine.disease, MESH: Odds Ratio, Obstetric Labor Complications, MESH: Apgar Score, MESH: Fetal Macrosomia, MESH: France, MESH : Pregnancy, MESH : Fetal Macrosomia, Reproductive Medicine, Apgar Score, Intensive Care, Neonatal, MESH: Intensive Care, Neonatal, MESH : Odds Ratio, business, MESH: Female, Postpartum period
Abstract

International audience; OBJECTIVES: To determine whether prenatal identification of macrosomia (≥4000g) reduces neonatal complications and maternal perineal lesions during delivery. STUDY DESIGN: This historical cohort study (n=14,684 from the National perinatal database of the Audipog Association, France) included women with cephalic singleton term pregnancies. Among the babies born with macrosomia, we compared those who had been identified as such in utero (n=1211) with those who were not (n=13,473). The principal outcome was a composite variable defined as resuscitation in the delivery room, death in the delivery room or the immediate postpartum period, or transfer to a neonatal intensive care unit (NICU). The secondary outcome measures were neonatal trauma, 5-min Apgar score (≤4 and

Published
2012
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4. [Evaluating a policy of restrictive episiotomy before and after practice guidelines by the French College of Obstetricians and Gynecologists]

Author

Eckman, A., Ramanah, R., Gannard, E., Clement, M. C., Collet, G., Courtois, L., Martin, A., Cossa, S., Maillet, R., Riethmuller, D., Centre d'études scientifiques et techniques d'Aquitaine ( CESTA ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ), Laboratoire d'Electrochimie et de Physico-chimie des Matériaux et des Interfaces ( LEPMI ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National Polytechnique de Grenoble ( INPG ) -Université Savoie Mont Blanc ( USMB [Université de Savoie] [Université de Chambéry] ) -Centre National de la Recherche Scientifique ( CNRS ), Immunologie et Chimie Thérapeutiques (ICT), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Centre d'études scientifiques et techniques d'Aquitaine (CESTA), Direction des Applications Militaires (DAM), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
Adult, MESH : Retrospective Studies, Attitude of Health Personnel, MESH: Obstetric Labor Complications, MESH : Episiotomy, MESH: Attitude of Health Personnel, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH : Obstetric Labor Complications, Obstetrical Forceps, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH: Pregnancy, MESH: Practice Guidelines as Topic, Pregnancy, Humans, MESH: Obstetrical Forceps, MESH : Obstetrical Forceps, MESH : Female, MESH : France, Retrospective Studies, MESH : Obstetrics, MESH: Humans, Health Policy, MESH : Humans, MESH: Adult, MESH: Retrospective Studies, MESH: Episiotomy, MESH : Adult, Obstetric Labor Complications, Obstetrics, MESH: France, MESH : Practice Guidelines as Topic, MESH : Pregnancy, Episiotomy, Practice Guidelines as Topic, Female, MESH: Health Policy, France, MESH : Health Policy, MESH: Female, MESH: Obstetrics, MESH : Attitude of Health Personnel
Abstract

International audience; AIM: To evaluate our practice following Clinical Practice Guidelines (CPG) of the French College of Obstetricians and Gynecologists (CNGOF) in 2005 advocating a policy of restrictive episiotomy and to show that a significative decrease in the rate of episiotomy does not increase the number of third and fourth degree perineal tears. MATERIAL AND METHODS: A retrospective study of episiotomies and third/fourth degree perineal tears of the year 2003 (before the CPG) was compared with the year 2007 (after the CPG). We analyzed the indications of episiotomies and compared the rate of episiotomies and severe perineal tears between the two periods. RESULTS: In 2003, the rate of episiotomies was 18.8% (upon 1755 vaginal deliveries). We observed 16 (9 per thousand) third-degree perineal tears, five of which was associated with episiotomies; and two (1 per thousand) fourth-degree perineal tears. In 2007, the rate of episiotomies was 3.4% (upon 1940 vaginal deliveries). There were eight (4 per thousand) third-degree and four (2 per thousand) fourth-degree perineal tears. The two periods of study were similar in terms of age, parity, gestational age, birthweight, rate of spontaneous deliveries, breech and instrumental deliveries. There were a difference regarding deliveries in the occipitoposterior position (5.8% vs 13.8% ; p=0.02). No significant difference was found between the rates of third degree (9 per thousand vs 4 per thousand ; p=0.059) and fourth degree perineal tears (1 per thousand vs 2 per thousand ; p=0.487). However, there was a significant decrease in the rate of episiotomies between the two periods (18.8% vs 3.4% ; p

Published
2010
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5. [Spontaneous rupture of the unscarred uterus during labor. Case report]

Author

Leung , F., Courtois , L., Aouar , Z., Bourtembourg , A., Eckman , A., Terzibachian , J. J., Maillet , R., Riethmuller , D., Centre d'études scientifiques et techniques d'Aquitaine (CESTA), Direction des Applications Militaires (DAM), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Immunologie et Chimie Thérapeutiques (ICT), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre d'études scientifiques et techniques d'Aquitaine ( CESTA ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
MESH: Obstetric Labor Complications, MESH : Young Adult, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH : Obstetric Labor Complications, MESH: Laparotomy, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, Young Adult, MESH: Pregnancy, Uterine Rupture, MESH : Laparotomy, Pregnancy, MESH : Uterus, Humans, MESH : Female, MESH : Rupture, Spontaneous, MESH: Puerperal Disorders, MESH: Rupture, Spontaneous, Laparotomy, MESH: Humans, Rupture, Spontaneous, MESH: Hysterotomy, MESH : Hysterotomy, Uterus, MESH : Humans, MESH : Puerperal Disorders, Puerperal Disorders, MESH: Uterine Rupture, Obstetric Labor Complications, MESH : Pregnancy, MESH: Young Adult, MESH : Uterine Rupture, MESH: Uterus, Female, Hysterotomy, MESH: Female
Abstract

International audience; We report a case of spontaneous uterine rupture in a 19 year-old patient Gravida 1 para 2 with no past history of uterine surgery. The diagnosis of uterine rupture, evoked in the early post-partum in the presence of acute abdominal pain, collapsus and haemoperitoneum on ultrasonography, was confirmed by laparotomy. Treatment consisted in hysterorrhaphy. The etiopathogenesis, clinical and therapeutical aspects of spontaneous unscarred uterine ruptures are discussed throughout a literature review.

Published
2009
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6. Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy

Author

Arnaud Fauconnier, Jean-Patrick Schaal, Xavier Fritel, Caroline Levet, A. Pigne, Violaine Bertrand, Service de gynécologie-obstétrique [Hôpital Rothschild], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de gynécologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Service de gynécologie-obstétrique [CHU Rothschild], and Fritel, Xavier

Subjects
Episiotomy, medicine.medical_treatment, MESH: Flatulence, Urinary incontinence, MESH: Female Urogenital Diseases, law.invention, 0302 clinical medicine, MESH: Pregnancy, Randomized controlled trial, law, MESH: Risk Factors, Pregnancy, Risk Factors, MESH: Dyspareunia, Fecal incontinence, Flatulence, 030212 general & internal medicine, 030219 obstetrics & reproductive medicine, Pelvic floor, MESH: Fecal Incontinence, Obstetrics, Cephalic presentation, Obstetrics and Gynecology, MESH: Episiotomy, Organizational Policy, 3. Good health, Obstetric labor complication, medicine.anatomical_structure, Dyspareunia, MESH: Pelvic Floor, Female, MESH: Pain, medicine.symptom, MESH: Urinary Incontinence, Adult, medicine.medical_specialty, MESH: Obstetric Labor Complications, Pain, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Article, 03 medical and health sciences, medicine, Humans, MESH: Humans, business.industry, MESH: Adult, Pelvic Floor, medicine.disease, Female Urogenital Diseases, Obstetric Labor Complications, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Urinary Incontinence, MESH: Organizational Policy, business, MESH: Female, Fecal Incontinence
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.

Published
2007
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7. [Liberal versus restrictive practice of episiotomy: do there exist specific obstetrical indications for episiotomy?]

Author

Riethmuller, D., Courtois, L., Maillet, R., Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Centre d'études scientifiques et techniques d'Aquitaine ( CESTA ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ), Immunologie et Chimie Thérapeutiques (ICT), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre d'études scientifiques et techniques d'Aquitaine (CESTA), Direction des Applications Militaires (DAM), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
Adult, MESH: Obstetric Labor Complications, MESH : Episiotomy, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH : Treatment Outcome, Perineum, MESH: Risk Assessment, MESH : Perineum, Risk Assessment, MESH : Obstetric Labor Complications, Fetal Macrosomia, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, Postoperative Complications, MESH: Pregnancy, Pregnancy, MESH: Postoperative Complications, Humans, MESH : Female, MESH : Risk Assessment, MESH: Perineum, MESH: Treatment Outcome, MESH: Puerperal Disorders, MESH: Humans, MESH : Humans, MESH : Puerperal Disorders, MESH: Adult, Puerperal Disorders, MESH: Episiotomy, MESH : Adult, Obstetric Labor Complications, MESH: Fetal Macrosomia, MESH : Pregnancy, Treatment Outcome, MESH : Fetal Macrosomia, Episiotomy, Female, MESH : Postoperative Complications, MESH: Female
Abstract

International audience; PURPOSE: To analyze the literature comparing two different policies for episotomy practice: liberal versus restrictive use. To search and discuss specific indications for episiotomy. METHODS: The Medline base was analyzed from 1970 to 2005. The articles where selected by using the key word episiotomy and selective or restrictive and routine or liberal. Every potential indications was crossed with episotomy. RESULTS: A policy implying a liberal practice of episiotomy is not better compared to a restrictive policy. The evidence-based medical literature favors avoiding routine episiotomy in low risk deliveries. Data are quite scarce concerning the different specific indications for episiotomy, and finally we can retain only one specific indication which is the short perineum when the distance between the fourchette and the center of the anus is less than 3 cm. Nevertheless, in order to improve delivery conditions obstetricians can advisably use episiotomy in accordance with their clinical assessment. CONCLUSION: There is no evidence in the literature favoring a liberal policy over a restrictive policy for the use of episiotomy, both in terms of fetal (Grade C) and maternal (Grade A) indications. A number of obstetrical situations considered as at risk do not systematically indicate an episiotomy. There are however circumstances in which a pertinent and prudent clinical assessment will lead the obstetrician to use an episiotomy.

Published
2006

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