title: [Pelvic floor disorders four years after first delivery: a comparative study of restrictive versus systematic episiotomy].
abstract: OBJECTIVE
  To compare two policies for episiotomy: restrictive and systematic.
  
  
  METHODS
  It is a quasi-randomised comparative study between two French university hospitals with contrasting episiotomy policies: one using it restrictively and the second routinely. Population included 774 nulliparous women delivered during 1996 of a singleton in cephalic presentation at a term of 37-41 weeks. A questionnaire was mailed four years after delivery. Sample size was calculated to allow showing a 10% difference in the prevalence of urinary incontinence with 80% power. Main outcome measures were 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, the groups did not differ in the prevalence of urinary incontinence (26% versus 32%), perineal pain (6% versus 8%), or pain during intercourse (18% versus 21%). 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 four years after first delivery.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Rothschild, Assistance publique-Hôpitaux de Paris (AP-HP), université Pierre-et-Marie-Curie, 33, boulevard de Picpus, 75012 Paris, France. fritel.xavier@orange.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 / Q000453:epidemiology / Q000209:etiology; D004841:Episiotomy / Q000009:adverse effects* / Q000379:methods*; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D052776:Female Urogenital Diseases / Q000453:epidemiology* / Q000209:etiology*; D005414:Flatulence / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007744:Obstetric Labor Complications / Q000601:surgery*; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D017773:Pelvic Floor / Q000473:pathology*; D011247:Pregnancy; D012307:Risk Factors; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology