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

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Created on : 06 Dec 2018
Modified on : 06 Dec 2018

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Bibliographical entry (without author) :

Prévention et protection périnéale en obstétrique (texte court). Recommandations pour la pratique clinique, Collège national des gynécologues et obstétriciens français.

Author(s) :

CNGOF

Year of publication :

2018

URL(s) :

http://www.cngof.fr/pratiques-cliniques/recommanda…

Résumé (français)  :

Introduction - L’objectif de ces Recommandations pour la pratique clinique (RPC) était d’analyser l’ensemble des interventions possibles au cours de la grossesse et de l’accouchement permettant de prévenir les lésions obstétricales du sphincter anal (LOSA) et les symptômes périnéaux postnataux.

Matériel et méthodes - Ces recommandations ont été élaborées selon la méthode décrite dans le guide méthodologique de la Haute Autorité de santé (HAS).

Résultats - En cas d’antécédent de maladie de Crohn, de LOSA, de mutilation sexuelle, ou de lésion périanale, un examen clinique prénatal du périnée est recommandé (accord professionnel). Juste après l’accouchement, il est recommandé d’examiner le périnée à la recherche d’une LOSA (grade B) ; en cas de doute diagnostique, il est recommandé de demander un second avis (grade C). En cas de LOSA, il est recommandé de décrire de manière détaillée les lésions (avec leur degré) ainsi que leur réparation (grade C). Le massage périnéal pendant la grossesse doit être encouragé chez les femmes souhaitant le pratiquer (grade B). Aucune intervention avant le dégagement de la présentation n’a clairement démontré son efficacité pour réduire le risque de lésions périnéales. Il est recommandé de contrôler manuellement le dégagement de la présentation céphalique et de soutenir le périnée postérieur afin de diminuer le risque de LOSA (grade C). Au cours d’un accouchement normal, la pratique d’une épisiotomie n’est pas recommandée pour réduire le risque de LOSA (grade A). En cas d’accouchement instrumental, une épisiotomie peut être indiquée pour éviter une LOSA (grade C). Lorsqu’une épisiotomie est réalisée, il est recommandé de choisir une incision médio- latérale (grade B). Il est recommandé d’expliquer l’indication et de recueillir l’accord de la femme avant de pratiquer une épisiotomie. Il n’est pas recommandé de proposer une césarienne programmée en prévention primaire de lésions ou de dysfonctions périnéales (grade B). Au cours de la grossesse et à nouveau en salle de travail, il est recommandé de s’intéresser aux attentes et d’informer les femmes sur les modalités de l’accouchement.

Abstract (English)  :

Introduction - The purpose of these Clinical Practice Guidelines (RPC) was to analyze all possible interventions during pregnancy and delivery to prevent obstetric anal sphincter lesions (LOSA) and postnatal perineal symptoms.

Materials and methods - These recommendations were developed according to the method described in the methodological guide of the High Authority of Health (HAS).

Results - In case of a history of Crohn’s disease, LOSA, sexual mutilation, or perianal lesion, a prenatal clinical examination of the perineum is recommended (professional agreement). Right after delivery, it is recommended to examine the perineum for LOSA (grade B); in case of diagnostic doubt, it is recommended to ask for a second opinion (grade C). In the case of LOSA, it is recommended to describe in detail the lesions (with their degree) as well as their repair (grade C). Perineal massage during pregnancy should be encouraged in women wishing to practice it (grade B). No intervention prior to release of the presentation clearly demonstrated its effectiveness in reducing the risk of perineal lesions. It is recommended to manually control the release of the cephalic presentation and support the posterior perineum to decrease the risk of LOSA (grade C). During normal delivery, the practice of an episiotomy is not recommended to reduce the risk of LOSA (grade A). In case of instrumental delivery, an episiotomy may be indicated to avoid LOSA (grade C). When an episiotomy is performed, it is recommended to choose a mediolateral incision (grade B). It is recommended to explain the indication and obtain the agreement of the woman before performing an episiotomy. It is not recommended to have scheduled cesarean section for primary prevention of perineal lesions or dysfunctions (grade B). During pregnancy and again in the workroom, it is recommended to focus on expectations and inform women about the modalities of delivery.

Sumário (português)  :

Introdução - O objetivo destas Diretrizes de Prática Clínica (RPC) foi analisar todas as possíveis intervenções durante a gravidez e o parto para prevenir lesões e sintomas do esfíncter anal obstétrico (LOSA) perineal pós-natal.

Materiais e métodos - Estas recomendações foram desenvolvidas de acordo com o método descrito no guia metodológico da Alta Autoridade de Saúde (HAS).

Resultados - Em caso de história de doença de Crohn, de LOSA, mutilação sexual ou lesão perianal, recomenda-se o exame clínico pré-natal do períneo (concordância profissional). Logo após o parto, recomenda-se examinar o períneo para LOSA (grau B); em caso de dúvida diagnóstica, recomenda-se solicitar uma segunda opinião (nota C). No caso de LOSA, recomenda-se descrever em detalhe as lesões (com o seu grau) bem como a sua reparação (grau C). Massagem perineal durante a gravidez deve ser incentivada em mulheres que desejam praticá-lo (grau B). Nenhuma intervenção antes da liberação da apresentação demonstrou claramente sua eficácia na redução do risco de lesões perineais. Recomenda-se controlar manualmente a liberação da apresentação cefálica e apoiar o períneo posterior para diminuir o risco de LOSA (grau C). Durante o parto normal, a prática de uma episiotomia não é recomendada para reduzir o risco de LOSA (Grau A). No caso de parto instrumental, uma episiotomia pode ser indicada para evitar LOSA (grau C). Quando uma episiotomia é realizada, recomenda-se escolher uma incisão médio-lateral (grau B). Recomenda-se explicar a indicação e obter o consentimento da mulher antes de realizar uma episiotomia. Não é recomendado ter uma cesariana programada para prevenção primária de lesões perineais ou disfunções (grau B). Durante a gravidez e novamente na sala de trabalho, recomenda-se concentrar-se nas expectativas e informar as mulheres sobre as modalidades de parto.

Full text (public) :

Comments :

Argument (français) :

L’objectif de ces Recommandations pour la pratique clinique (RPC) était d’analyser l’ensemble des interventions possibles au cours de la grossesse et de l’accouchement permettant de prévenir les lésions obstétricales du sphincter anal (LOSA) et les symptômes périnéaux postnataux

Argument (English):

The objective of these Clinical Practice Guidelines (RPC) was to analyze all possible interventions during pregnancy and delivery to prevent obstetric anal sphincter lesions and postnatal perineal symptoms.

Argumento (português):

O objetivo destas Diretrizes de Prática Clínica (RPC) foi analisar todas as possíveis intervenções durante a gravidez e parto para prevenir lesões do esfíncter anal obstétrico e sintomas perineais pós-natais.

Keywords :

➡ evidence-based medicine/midwifery ; guidelines ; perineal/vaginal tears ; deontology ; episiotomy

Author of this record :

Bernard Bel — 06 Dec 2018

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