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Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries

Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rat...

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Autores principales: Clesse, Christophe, Cottenet, Jonathan, Lighezzolo-Alnot, Joelle, Goueslard, Karine, Scheffler, Michele, Sagot, Paul, Quantin, Catherine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677317/
https://www.ncbi.nlm.nih.gov/pubmed/33214621
http://dx.doi.org/10.1038/s41598-020-70881-7
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author Clesse, Christophe
Cottenet, Jonathan
Lighezzolo-Alnot, Joelle
Goueslard, Karine
Scheffler, Michele
Sagot, Paul
Quantin, Catherine
author_facet Clesse, Christophe
Cottenet, Jonathan
Lighezzolo-Alnot, Joelle
Goueslard, Karine
Scheffler, Michele
Sagot, Paul
Quantin, Catherine
author_sort Clesse, Christophe
collection PubMed
description Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N = 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p < 0.01), and from 15.5 to 9.3% (p < 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥ 4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks.
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spelling pubmed-76773172020-11-23 Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries Clesse, Christophe Cottenet, Jonathan Lighezzolo-Alnot, Joelle Goueslard, Karine Scheffler, Michele Sagot, Paul Quantin, Catherine Sci Rep Article Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N = 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p < 0.01), and from 15.5 to 9.3% (p < 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥ 4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks. Nature Publishing Group UK 2020-11-19 /pmc/articles/PMC7677317/ /pubmed/33214621 http://dx.doi.org/10.1038/s41598-020-70881-7 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Clesse, Christophe
Cottenet, Jonathan
Lighezzolo-Alnot, Joelle
Goueslard, Karine
Scheffler, Michele
Sagot, Paul
Quantin, Catherine
Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries
title Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries
title_full Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries
title_fullStr Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries
title_full_unstemmed Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries
title_short Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries
title_sort episiotomy practices in france: epidemiology and risk factors in non-operative vaginal deliveries
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677317/
https://www.ncbi.nlm.nih.gov/pubmed/33214621
http://dx.doi.org/10.1038/s41598-020-70881-7
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