[From the impact of French guidelines to reduce episiotomy's rate].
OBJECTIVE
Following the publication of the French Guidelines on episiotomy in 2005 by the French National College of Gynaecologists and Obstetricians (CNGOF), our unit decided to adopt a restrictive politics to replace the former liberal one. The goal of this study was to evaluate the impact of this modification of trend in the Unit of Gynaecology and Obstetrics of the teaching hospital from Caen. This was the start point of an internal audit with the objective of an enhancement of the care during delivery.


METHODS
It was a retrospective study concerning the period going from January, 2004 till December, 2009, measuring the impact of the guidelines on the episiotomy rates and perineal tears. The totality of the population of the women naturally delivered at a term superior or equal to 37 weeks of gestation and a cephalic presentation was included. To modify the practices, after diffusion of the guidelines by some obstetrical leaders, we imposed to notify the indication of the episiotomy in the computerized obstetrical files. Moreover, we published monthly screenboards with all the detailed results to all the practioners acting in the delivery room (obstetricians, midwives).


RESULTS
Between 2004 and 2009, we observed a dramatic decline of the episiotomy rates from 55.7 to 13.3%. This trend was the same for primiparae and multiparae, as wall as for spontaneous or assisted delivery (mostly vacuum extraction in our unit). We noticed a slight increased in minor perineal tears without functional consequences. There was no statistically significant difference between severe perineal tear (1.3% vs. 1.1%). By contrary, the rate of intact perineum significantly raised (17.6% vs. 21.7%, p<0.001), especially in vacuum extractions.


CONCLUSIONS
Our results are in accordance with those of the national guidelines. However, our rate does not decrease in 2007 and 2008 (20%), contrary to some results obtained in the literature. Some reports mentioned the weak impact of the publication of national guidelines to modify the usual practice. However, we believe that retro-information to practitioners has a real impact on their daily current practice. Hence we insisted again on the importance of these national guidelines at the end of 2008 and we could demonstrate a real decline of the rate of episiotomy. Our efforts have to be continued, especially for instrumental delivery.
Service de gynécologie-obstétrique et de médecine de reproduction, CHU de Caen, bâtiment FEH, avenue de La-Côte-de-Nacre, 14033 Caen cedex 09, France. reinbold-d@chu-caen.fr
D
D
Reinbold
C
C
Eboue
R
R
Morello
N
N
Lamendour
M
M
Herlicoviez
M
M
Dreyfus
D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D006801:Humans; D022125:Lacerations / Q000453:epidemiology*; D008485:Medical Audit; D010298:Parity; D010502:Perineum / Q000293:injuries*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012189:Retrospective Studies