Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 09 May 2005
Modified on : 01 Dec 2007

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Bibliographical entry (without author) :

Outcomes of Routine Episiotomy. A Systematic Review. The Journal of the American Medical Association, May 4, 2005, vol 293:2141-2148.

Author(s) :

Hartmann, K., Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr., Lohr KN

Year of publication :

2005

URL(s) :

http://jama.ama-assn.org/cgi/reprint/293/17/2141

Résumé (français)  :

Abstract (English)  :

Context

Episiotomy at the time of vaginal birth is common. Practice patterns vary widely, as do professional opinions about maternal risks and benefits associated with routine use. Objective To systematically review the best evidence available about maternal outcomes of routine vs restrictive use of episiotomy.

Evidence Acquisition

We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Collaboration resources and performed a hand search for English-language articles from 1950 to 2004. We included randomized controlled trials of routine episiotomy or type of episiotomy that assessed outcomes in the first 3 postpartum months, along with trials and prospective studies that assessed longer-term outcomes. Twenty-six of 986 screened articles provided relevant data. We entered data into abstraction forms and conducted a second review for accuracy. Each article was also scored for research quality.

Evidence Synthesis

Fair to good evidence from clinical trials suggests that immediate maternal outcomes of routine episiotomy, including severity of perineal laceration, pain, and pain medication use, are not better than those with restrictive use. Evidence is insufficient to provide guidance on choice of midline vs mediolateral episiotomy. Evidence regarding long-term sequelae is fair to poor. Incontinence and pelvic floor outcomes have not been followed up into the age range in which women are most likely to have sequelae. With this caveat, relevant studies are consistent in demonstrating no benefit from episiotomy for prevention of fecal and urinary incontinence or pelvic floor relaxation. Likewise, no evidence suggests that episiotomy reduces impaired sexual function— pain with intercourse was more common among women with episiotomy.

Conclusions

Evidence does not support maternal benefits traditionally ascribed to rou-tine episiotomy. In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had a surgical incision.

Sumário (português)  :

Full text (private) :

Comments :

See also

Episiotomy May Not Help Most Mothers
http://my.webmd.com/content/article/105/107840.htm

Argument (français) :

Argument (English):

Episiotomy -- a surgical cut routinely done to reduce the risk of
tears during vaginal delivers -- offers no health benefits to women,
research shows.

Argumento (português):

Keywords :

➡ episiotomy ; perineal/vaginal tears ; incontinence/prolapsus ; maternal age

Author of this record :

Bernard Bel — 09 May 2005