Volume 8, Issue 6, November 2020, Page: 174-178
Restriction of Episiotomy: Obstetrical Indications and Perineal Prognosis in Two Maternity Wards in Brazzaville (Republic of Congo)
Buambo Gauthier Regis Jostin, Obstetrics Gynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo
Ele Elenga Varel Pirnet, Obstetrics Gynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo
Potokoue Mpia Samantha Nuelly, Obstetrics GFaculty of Health Sciences, Marien NGOUABI University, Brazzaville, Congoynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo;
Mokoko Jules Cesar, Obstetrics GFaculty of Health Sciences, Marien NGOUABI University, Brazzaville, Congoynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo;
Itoua Clautaire, Obstetrics GFaculty of Health Sciences, Marien NGOUABI University, Brazzaville, Congoynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo;
Iloki Leon Herve, Obstetrics GFaculty of Health Sciences, Marien NGOUABI University, Brazzaville, Congoynecology Department, University Hospital Centre of Brazzaville, Brazzaville, Congo;
Received: Oct. 18, 2020;       Accepted: Oct. 28, 2020;       Published: Nov. 9, 2020
DOI: 10.11648/j.jgo.20200806.14      View  34      Downloads  20
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.
Keywords
Episiotomy, Restriction, Impact, Childbirth, Brazzaville
To cite this article
Buambo Gauthier Regis Jostin, Ele Elenga Varel Pirnet, Potokoue Mpia Samantha Nuelly, Mokoko Jules Cesar, Itoua Clautaire, Iloki Leon Herve, Restriction of Episiotomy: Obstetrical Indications and Perineal Prognosis in Two Maternity Wards in Brazzaville (Republic of Congo), Journal of Gynecology and Obstetrics. Vol. 8, No. 6, 2020, pp. 174-178. doi: 10.11648/j.jgo.20200806.14
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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