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

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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https://www.hal.inserm.fr/inserm-00356856
Contributor : Xavier Fritel <>
Submitted on : Thursday, February 26, 2009 - 6:44:15 PM
Last modification on : Wednesday, August 19, 2020 - 11:16:58 AM
Long-term archiving on: : Wednesday, September 22, 2010 - 11:39:50 AM

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Xavier Fritel, Jean-Patrick Schaal, Arnaud Fauconnier, Violaine Bertrand, Caroline Levet, et al.. Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy.. BJOG An International Journal of Obstetrics and Gynaecology, 2008, 115 (2), pp.247-52. ⟨10.1111/j.1471-0528.2007.01540.x⟩. ⟨inserm-00356856v2⟩

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