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Katariina Laine - One of the best experts on this subject based on the ideXlab platform.
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effect of different Episiotomy techniques on perineal pain and sexual activity 3 months after delivery
International Urogynecology Journal, 2014Co-Authors: Kathrine Fodstad, Katariina Laine, Anne Cathrine StaffAbstract:Introduction and hypothesis The effect of different Episiotomy techniques on pain perception 3 months after delivery is unknown.Studyaimswere to explore the association between different Episiotomy techniques and perineal pain 3 months after deliveryand toassessfemalesexualactivity inrelationto Episiotomy technique. Methods This is a prospective observational study, designed to investigate short- and long-term complications of different Episiotomy techniques. All 300 participants were recruited and clinically examined during their postpartum hospital stay in order to evaluate Episiotomy performance. A 3-month follow-up questionnaire addressing pain, sexual activity, and puerperal wound infection was distributed to 208 women who had scored perineal pain in a personal interview the first day after delivery. Results A response rate of 87.7 % was obtained. We found no difference in pain score distribution by Visual Analogue Scale (VAS) when comparing midline, mediolateral, and lateral Episiotomy techniques (p=0.32) or between midline and lateralincisionpoints(p=0.58). Dyspareunia was reported by 33 out of 179 women, but no difference between Episiotomy techniques (p=0.90), or between Episiotomy incision points (p=0.14), was found. Perineal wound infection was reported by 9.5 %, but there was no significant difference between Episiotomy techniques (p=0.73). Conclusions No difference was found in perineal pain perception 3 months postpartum between different Episiotomy techniques or when comparing midline and lateral incision points. Dyspareunia was not associated with any particular Episiotomy technique or incision point.
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changing associations of Episiotomy and anal sphincter injury across risk strata results of a population based register study in finland 2004 2011
BMJ Open, 2013Co-Authors: Sari Raisanen, Rufus Cartwright, Mika Gissler, Michael R Kramer, Katariina Laine, Maijariitta Jouhki, Seppo HeinonenAbstract:Objectives: To evaluate the changing association between lateral Episiotomy and obstetric anal sphincter injury (OASIS) for women with low and high baseline risk of OASIS. Design: A population-based register study. Setting: Data gathered from the Finnish Medical Birth Register for the years 2004−2011. Participants: All women with spontaneous vaginal or vacuum-assisted singleton births in Finland (n=384 638). Main outcome measure: OASIS incidence. Results: During the study period, the incidence of OASIS increased from 1.3% to 1.7% in women with first vaginal births, including women admitted for first vaginal birth after a prior caesarean section and from 0.1% to 0.3% in women with at least one prior birth, whereas Episiotomy rates declined from 56.7% to 45.5% and 10.1– 5.3%, respectively. At the study onset, when Episiotomy was used more widely, it was negatively associated with OASIS in women with first vaginal births, but as Episiotomy use declined it became positively associated with OASIS. Women with Episiotomy were complicated by OASIS with clearly higher risk scores than women without Episiotomy suggesting that Episiotomy was clearly protective against OASIS. OASIS occurred with lower mean risk scores among women with and without Episiotomy over time. However, OASIS incidences increased only among women with Episiotomy, whereas it decreased or remained among women without Episiotomy. Conclusions: The cross-over effect between Episiotomy and OASIS could be explained by increasing disparity in baseline OASIS risk between treated and untreated women, since Episiotomy use declined most in women at low OASIS risk. Episiotomy rate can be safely reduced in low-risk women but interestingly along with the policy change the practice to cut the Episiotomy became less protective among high-risk women.
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different Episiotomy techniques postpartum perineal pain and blood loss an observational study
International Urogynecology Journal, 2013Co-Authors: Katariina Laine, Kathrine Fodstad, Anne Cathrine StaffAbstract:The lateral Episiotomy technique has been postulated to cause more postpartum perineal pain and blood loss compared to the midline and mediolateral Episiotomy technique. The aim of the study was to explore the association with postpartum perineal pain and blood loss between different Episiotomy techniques. Clinical evaluation of Episiotomy was performed 0–3 days after delivery on 300 participating women. Episiotomy technique was classified by millimeter distance from the incision point to the posterior fourchette and by angle from the sagittal plane in degrees. Postpartum perineal pain was scored on a visual analogue scale (VAS) the first day after delivery. Blood loss data were collected from medical charts. Different Episiotomy techniques and different Episiotomy incision point groups were compared in relation to perineal pain perception and blood loss. We found no difference between midline, mediolateral, and lateral Episiotomy techniques in perineal pain perception the first postpartum day (p = 0.74) or in estimated blood loss (p = 0.38). No differences were found in perineal pain or blood loss between midline and lateral incision points. Mediolateral angles were significantly narrower than lateral angles (p < 0.005). Physicians performed longer episiotomies than midwives (p < 0.005), but Episiotomy angle did not vary between professions (p = 0.075). No differences in perineal pain perception the first postpartum day and no differences in estimated blood loss were found when comparing different Episiotomy techniques or when comparing midline and lateral incision points.
Catherine Quantin - One of the best experts on this subject based on the ideXlab platform.
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A novel classification for evaluating Episiotomy practices: application to the Burgundy perinatal network
BMC Pregnancy and Childbirth, 2019Co-Authors: Thomas Desplanches, Jonathan Cottenet, Catherine Quantin, Emilie Szczepanski, Denis Semama, Paul SagotAbstract:BACKGROUND: Though the rate of Episiotomy has decreased in France, the overall Episiotomy rate was 20% in the 2016 national perinatal survey. We aimed to develop a classification to facilitate the analysis of Episiotomy practices and to evaluate whether Episiotomy is associated with a reduction in the rate of obstetric anal sphincter injuries (OASIS) for each subgroup. METHODS: This population-based study included all the deliveries that occurred in the Burgundy Perinatal Network from 2011 to 2016. The main outcome was Episiotomy, which was identified thanks to the French Common Classification of Medical Procedures. An ascending hierarchical cluster analysis was performed to build the classification. A clinical audit using the classification was conducted yearly in all obstetric units. The Episiotomy rates were described throughout the study period for each subgroup of the classification. The OASIS rates were evaluated by subgroup and the association between mediolateral Episiotomy and OASIS was investigated for each subgroup. RESULTS: Our analyses included 81,290 pregnant women. The classification comprised 7 subgroups: (1) nulliparous single cephalic at term, (2) nulliparous single cephalic at term with instrumental delivery, (3) multiparous single cephalic at term, (4) multiparous single cephalic at term with instrumental delivery, (5) all preterm deliveries (
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How did Episiotomy rates change from 2007 to 2014? Population-based study in France
BMC Pregnancy and Childbirth, 2018Co-Authors: Karine Goueslard, Jonathan Cottenet, Adrien Roussot, Christophe Clesse, Paul Sagot, Catherine QuantinAbstract:BACKGROUND: Since the 2000s, selective Episiotomy has been systematically recommended worldwide. In France, the recommended Episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of Episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with Episiotomy. METHODS: This population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of Episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The Episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with Episiotomy for non-operative vaginal deliveries and the risk factors related to the women's characteristics and the birth environment. RESULTS: There were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national Episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of Episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23-1.30]), epidural analgesia (aOR = 1.45 [1.43-1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47-1.49]), and giving birth for the first time (aOR = 3.85 [3.84-4.00]). CONCLUSIONS: The Episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant.
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how did Episiotomy rates change from 2007 to 2014 population based study in france
BMC Pregnancy and Childbirth, 2018Co-Authors: Karine Goueslard, Jonathan Cottenet, Adrien Roussot, Christophe Clesse, Paul Sagot, Catherine QuantinAbstract:Since the 2000s, selective Episiotomy has been systematically recommended worldwide. In France, the recommended Episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of Episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with Episiotomy. This population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of Episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The Episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with Episiotomy for non-operative vaginal deliveries and the risk factors related to the women’s characteristics and the birth environment. There were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national Episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of Episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23–1.30]), epidural analgesia (aOR = 1.45 [1.43–1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47–1.49]), and giving birth for the first time (aOR = 3.85 [3.84–4.00]). The Episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant.
E. Gonzalez-díaz - One of the best experts on this subject based on the ideXlab platform.
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Trigonometric characteristics of Episiotomy and risks for obstetric anal sphincter injuries in operative vaginal delivery
International Urogynecology Journal, 2015Co-Authors: E. Gonzalez-díaz, L. Moreno Cea, A. Fernández CoronaAbstract:Introduction and hypothesis The objective of this study was to investigate the association between the trigonometric properties of Episiotomy in operative vaginal delivery (OVD) and obstetric anal sphincter injuries (OASIS). Methods The study included 72 primiparous women who had an OVD and Episiotomy. Cases ( n = 36) had sustained OASIS at birth, while controls ( n = 36) had not. The groups were matched for instrumental delivery. The Episiotomy scar was identified and its trigonometric characteristics were measured at 8–12 weeks postpartum. Data were analysed using conditional logistic analysis. Results The angle of Episiotomy behaves as a factor associated with anal sphincter injury, so women with a mediolateral Episiotomy and an angle greater than 20° have an 87 % less risk of having an OASIS (odds ratio 0.13, 95 % confidence interval 0.03–0.58). The study showed that scarred episiotomies at 8–12 weeks after OVD with an angle ≤ 20°, depth and distance between the Episiotomy and anus ≤ 15 mm, total upper triangle perimeter ≤ 75 mm, para-anal triangle perimeter ≤ 15 mm and areas between scar and midline ≤ 250 mm^2 were significantly associated with higher risk of OASIS. Conclusions When a mediolateral Episiotomy is performed in OVD the technique has a strong effect on the occurrence of OASIS. Additional research is needed to determine if the optimal technique for mediolateral episiotomies produces less OASIS than deferring the performance of Episiotomy.
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Trigonometric characteristics of Episiotomy and risks for obstetric anal sphincter injuries in operative vaginal delivery.
International urogynecology journal, 2014Co-Authors: E. Gonzalez-díaz, L. Moreno Cea, A. Fernández CoronaAbstract:The objective of this study was to investigate the association between the trigonometric properties of Episiotomy in operative vaginal delivery (OVD) and obstetric anal sphincter injuries (OASIS). The study included 72 primiparous women who had an OVD and Episiotomy. Cases (n = 36) had sustained OASIS at birth, while controls (n = 36) had not. The groups were matched for instrumental delivery. The Episiotomy scar was identified and its trigonometric characteristics were measured at 8–12 weeks postpartum. Data were analysed using conditional logistic analysis. The angle of Episiotomy behaves as a factor associated with anal sphincter injury, so women with a mediolateral Episiotomy and an angle greater than 20° have an 87 % less risk of having an OASIS (odds ratio 0.13, 95 % confidence interval 0.03–0.58). The study showed that scarred episiotomies at 8–12 weeks after OVD with an angle ≤ 20°, depth and distance between the Episiotomy and anus ≤ 15 mm, total upper triangle perimeter ≤ 75 mm, para-anal triangle perimeter ≤ 15 mm and areas between scar and midline ≤ 250 mm2 were significantly associated with higher risk of OASIS. When a mediolateral Episiotomy is performed in OVD the technique has a strong effect on the occurrence of OASIS. Additional research is needed to determine if the optimal technique for mediolateral episiotomies produces less OASIS than deferring the performance of Episiotomy.
Paul Sagot - One of the best experts on this subject based on the ideXlab platform.
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A novel classification for evaluating Episiotomy practices: application to the Burgundy perinatal network
BMC Pregnancy and Childbirth, 2019Co-Authors: Thomas Desplanches, Jonathan Cottenet, Catherine Quantin, Emilie Szczepanski, Denis Semama, Paul SagotAbstract:BACKGROUND: Though the rate of Episiotomy has decreased in France, the overall Episiotomy rate was 20% in the 2016 national perinatal survey. We aimed to develop a classification to facilitate the analysis of Episiotomy practices and to evaluate whether Episiotomy is associated with a reduction in the rate of obstetric anal sphincter injuries (OASIS) for each subgroup. METHODS: This population-based study included all the deliveries that occurred in the Burgundy Perinatal Network from 2011 to 2016. The main outcome was Episiotomy, which was identified thanks to the French Common Classification of Medical Procedures. An ascending hierarchical cluster analysis was performed to build the classification. A clinical audit using the classification was conducted yearly in all obstetric units. The Episiotomy rates were described throughout the study period for each subgroup of the classification. The OASIS rates were evaluated by subgroup and the association between mediolateral Episiotomy and OASIS was investigated for each subgroup. RESULTS: Our analyses included 81,290 pregnant women. The classification comprised 7 subgroups: (1) nulliparous single cephalic at term, (2) nulliparous single cephalic at term with instrumental delivery, (3) multiparous single cephalic at term, (4) multiparous single cephalic at term with instrumental delivery, (5) all preterm deliveries (
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How did Episiotomy rates change from 2007 to 2014? Population-based study in France
BMC Pregnancy and Childbirth, 2018Co-Authors: Karine Goueslard, Jonathan Cottenet, Adrien Roussot, Christophe Clesse, Paul Sagot, Catherine QuantinAbstract:BACKGROUND: Since the 2000s, selective Episiotomy has been systematically recommended worldwide. In France, the recommended Episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of Episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with Episiotomy. METHODS: This population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of Episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The Episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with Episiotomy for non-operative vaginal deliveries and the risk factors related to the women's characteristics and the birth environment. RESULTS: There were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national Episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of Episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23-1.30]), epidural analgesia (aOR = 1.45 [1.43-1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47-1.49]), and giving birth for the first time (aOR = 3.85 [3.84-4.00]). CONCLUSIONS: The Episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant.
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how did Episiotomy rates change from 2007 to 2014 population based study in france
BMC Pregnancy and Childbirth, 2018Co-Authors: Karine Goueslard, Jonathan Cottenet, Adrien Roussot, Christophe Clesse, Paul Sagot, Catherine QuantinAbstract:Since the 2000s, selective Episiotomy has been systematically recommended worldwide. In France, the recommended Episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of Episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with Episiotomy. This population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of Episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The Episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with Episiotomy for non-operative vaginal deliveries and the risk factors related to the women’s characteristics and the birth environment. There were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national Episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of Episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23–1.30]), epidural analgesia (aOR = 1.45 [1.43–1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47–1.49]), and giving birth for the first time (aOR = 3.85 [3.84–4.00]). The Episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant.
Anne Cathrine Staff - One of the best experts on this subject based on the ideXlab platform.
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effect of different Episiotomy techniques on perineal pain and sexual activity 3 months after delivery
International Urogynecology Journal, 2014Co-Authors: Kathrine Fodstad, Katariina Laine, Anne Cathrine StaffAbstract:Introduction and hypothesis The effect of different Episiotomy techniques on pain perception 3 months after delivery is unknown.Studyaimswere to explore the association between different Episiotomy techniques and perineal pain 3 months after deliveryand toassessfemalesexualactivity inrelationto Episiotomy technique. Methods This is a prospective observational study, designed to investigate short- and long-term complications of different Episiotomy techniques. All 300 participants were recruited and clinically examined during their postpartum hospital stay in order to evaluate Episiotomy performance. A 3-month follow-up questionnaire addressing pain, sexual activity, and puerperal wound infection was distributed to 208 women who had scored perineal pain in a personal interview the first day after delivery. Results A response rate of 87.7 % was obtained. We found no difference in pain score distribution by Visual Analogue Scale (VAS) when comparing midline, mediolateral, and lateral Episiotomy techniques (p=0.32) or between midline and lateralincisionpoints(p=0.58). Dyspareunia was reported by 33 out of 179 women, but no difference between Episiotomy techniques (p=0.90), or between Episiotomy incision points (p=0.14), was found. Perineal wound infection was reported by 9.5 %, but there was no significant difference between Episiotomy techniques (p=0.73). Conclusions No difference was found in perineal pain perception 3 months postpartum between different Episiotomy techniques or when comparing midline and lateral incision points. Dyspareunia was not associated with any particular Episiotomy technique or incision point.
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different Episiotomy techniques postpartum perineal pain and blood loss an observational study
International Urogynecology Journal, 2013Co-Authors: Katariina Laine, Kathrine Fodstad, Anne Cathrine StaffAbstract:The lateral Episiotomy technique has been postulated to cause more postpartum perineal pain and blood loss compared to the midline and mediolateral Episiotomy technique. The aim of the study was to explore the association with postpartum perineal pain and blood loss between different Episiotomy techniques. Clinical evaluation of Episiotomy was performed 0–3 days after delivery on 300 participating women. Episiotomy technique was classified by millimeter distance from the incision point to the posterior fourchette and by angle from the sagittal plane in degrees. Postpartum perineal pain was scored on a visual analogue scale (VAS) the first day after delivery. Blood loss data were collected from medical charts. Different Episiotomy techniques and different Episiotomy incision point groups were compared in relation to perineal pain perception and blood loss. We found no difference between midline, mediolateral, and lateral Episiotomy techniques in perineal pain perception the first postpartum day (p = 0.74) or in estimated blood loss (p = 0.38). No differences were found in perineal pain or blood loss between midline and lateral incision points. Mediolateral angles were significantly narrower than lateral angles (p < 0.005). Physicians performed longer episiotomies than midwives (p < 0.005), but Episiotomy angle did not vary between professions (p = 0.075). No differences in perineal pain perception the first postpartum day and no differences in estimated blood loss were found when comparing different Episiotomy techniques or when comparing midline and lateral incision points.