[Can we reduce the episotomy rate?].
OBJECTIVE
Determine whether scientific evidence supports an "appropriate" episiotomy rate - and whether this rate can be reduced via medical intervention and or preventive actions during pregnancy or at the time of delivery.


METHODS
A survey of the literature available on Medline and the Cochrane Library between 1980 and 2005 and dealing with the objectives of the present study was undertaken.


RESULTS
In France, the national episiotomy rate should not reach 30%. A program aiming at continuous improvement in quality-of-care after episiotomy and including various actions - training courses, audits, presence of a staff leader, episiotomy rate feedback per midwife or obstetrician - could help reduce the use of episiotomies (grade B). There is insufficient scientific data available to recommend perineal massaging or pre-birth perineal physiotherapy (grade B), and the benefits of a pre-birth training course on the perineum are still to be assessed (grade C). A pregnancy-long support provided to a woman by the same professional could reduce the use of episiotomies but not resorting to perineum repair (grade B). The effects of various types of pre-birth training courses on the perineum are unknown (grade C). We lack scientific data to promote perineal massaging during labor (grade B). Some studies show that an upright position during the second stage of labor is less harmful to the perineum than the classical dorsal reclining position, however it can increase the possibility of post-partum hemorrhage (grade B). Scientific proof is not sufficient to advise favoring a particular type of pushing or a specific manner to release the baby's head (grade B).


CONCLUSIONS
More randomized studies are necessary to assess the relevance of all these preventive measures as regards the use of episiotomies.
farruel-fosse-helene@wanadoo.fr
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Faruel-Fosse
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Vendittelli
D000328:Adult; D004841:Episiotomy / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007748:Labor Stage, Second / Q000502:physiology; D008405:Massage / Q000379:methods; D010502:Perineum / Q000293:injuries / Q000502:physiology / Q000601:surgery; D011247:Pregnancy; D011295:Prenatal Care