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Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy
Author(s) -
Fritel X,
Schaal JP,
Fauconnier A,
Bertrand V,
Levet C,
Pigné A
Publication year - 2008
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2007.01540.x
Subject(s) - episiotomy , medicine , urinary incontinence , perineum , obstetrics , logistic regression , pelvic floor , population , gynecology , pregnancy , surgery , genetics , environmental health , biology
Objective To compare two policies for episiotomy: restrictive and systematic. Design Quasi‐randomised comparative study. Setting Two French university hospitals with contrasting policies for episiotomy: one using episiotomy restrictively and the second routinely. Population Seven hundred and seventy‐four nulliparous women delivered during 1996 of a singleton in cephalic presentation at a term of 37–41 weeks. Methods A questionnaire was mailed 4 years after delivery. Sample size was calculated to allow us to show a 10% difference in the prevalence of urinary incontinence with 80% power. Main outcome measures Urinary incontinence, anal incontinence, perineal pain, and pain during intercourse. Results We received 627 responses (81%), 320 from women delivered under the restrictive policy, 307 from women delivered under the routine policy. In the restrictive group, 186 (49%) deliveries included mediolateral episiotomies and in the routine group, 348 (88%). Four years after the first delivery, there was no difference in the prevalence of urinary incontinence (26 versus 32%), perineal pain (6 versus 8%), or pain during intercourse (18 versus 21%) between the two groups. Anal incontinence was less prevalent in the restrictive group (11 versus 16%). The difference was significant for flatus (8 versus 13%) but not for faecal incontinence (3% for both groups). Logistic regression confirmed that a policy of routine episiotomy was associated with a risk of anal incontinence nearly twice as high as the risk associated with a restrictive policy (OR = 1.84, 95% CI: 1.05–3.22). Conclusions A policy of routine episiotomy does not protect against urinary or anal incontinence 4 years after first delivery.