title: Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy.
abstract: OBJECTIVE
  To compare two policies for episiotomy: restrictive and systematic.
  
  
  METHODS
  Quasi-randomised comparative study.
  
  
  METHODS
  Two French university hospitals with contrasting policies for episiotomy: one using episiotomy restrictively and the second routinely.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Service de Gynécologie & Obstétrique, Hôpital Rothschild AP-HP, Université Pierre-et-Marie-Curie, Paris, France. x-fritel@chd-fguyon.fr
authors.forename: X
authors.initials: X
authors.lastname: Fritel
authors.forename: J P
authors.initials: JP
authors.lastname: Schaal
authors.forename: A
authors.initials: A
authors.lastname: Fauconnier
authors.forename: V
authors.initials: V
authors.lastname: Bertrand
authors.forename: C
authors.initials: C
authors.lastname: Levet
authors.forename: A
authors.initials: A
authors.lastname: Pigné
mesh_terms: D000328:Adult; D004414:Dyspareunia / Q000209:etiology; D004841:Episiotomy / Q000009:adverse effects* / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D052776:Female Urogenital Diseases / Q000209:etiology*; D005414:Flatulence / Q000209:etiology; D006801:Humans; D007744:Obstetric Labor Complications / Q000601:surgery*; D016134:Organizational Policy; D010146:Pain / Q000209:etiology; D017773:Pelvic Floor; D011247:Pregnancy; D012307:Risk Factors; D014549:Urinary Incontinence / Q000209:etiology