[Maternal and neonatal consequences induced by the French recommendations for episiotomy practice. Monocentric study about 5409 vaginal deliveries].

OBJECTIVES

Recommendations for clinical practice (RPC) edited by the College of French gynecologists and obstetricians (CNGOF) claim for a more restrictive use of episiotomy. The aims of this study were to assess the impact of these recommendations on episiotomy practice and to evaluate maternal and neonatal outcomes of a more restrictive approach.

PATIENTS AND METHODS

We compared in a retrospective analysis episiotomy practice, maternal and neonatal consequences of a restrictive episiotomy policy between 2004 and 2006 (before and after recommendations publication) in a level III maternity unit. Identification of risks factors for episiotomy practice in our population was based on a multivariate analysis.

RESULTS

Two thousand and five hundred and 2909 patients who delivered vaginally respectively in 2004 and 2006 were included. In 2006, fewer episiotomies were performed (43.48% vs 32.32%, p<0.0001) and more grade I and II perineal tears occurred (27.56% vs 36.61%, p=0.0001) whereas the anal sphincter tear rate remained constant (0.48% vs 0.69%, p=0.376). Neonatal condition assessed by the Apgar score was also stable. In multivariate analysis, risk factors for episiotomy already described in the literature were significant in our study and year 2006 was associated with less use of episiotomy in comparison with year 2004 (OR: 0.499; IC: 0.44-0.57; p<0.0001).

DISCUSSION AND CONCLUSION

In our institution, French guidelines were followed by a reduction in the use of episiotomy practice without increasing the risk for severe perineal tear or neonatal distress.