title: [Impact of a major decrease in the use of episiotomy on perineal tears in a level III maternity ward].
abstract: OBJECTIVE
  To evaluate the perineal outcome after a major decrease in episiotomy rate in a high-risk (level III) maternity ward.
  
  
  METHODS
  This was a retrospective cohort study in a teaching high-risk maternity comparing perineal tears between 2003 and 2010. We included for analysis: pregnancies at 25 weeks or more, fetal birthweights of 500 g or more, vaginal deliveries in our maternity, singletons or multiple pregnancies, cephalic or breech presentations.
  
  
  RESULTS
  The two populations were comparable. In 2003, we performed 18.8% of episiotomies and 1.3% in 2010. Between these years, our intact perineum rate increased from 28.8 to 37.5% (P<0.0001). We also report an increase in first and second degree perineum lesions (20.5% in 2003 and 40.2% in 2010, P<0.0001) and anterior perineal lesions (17.8% in 2003 and 30.3% in 2010, P<0.0001). We also report a significant decrease in perineal lesions with sphincter injuries (1% in 2003 and 0.3% in 2010 P<0.0001).
  
  
  CONCLUSIONS
  Comparing 2003 to 2010, the majority of cases with no episiotomy (over 2/3) resulted in first degree perineum lesions which are today recognized as benign lesions without any systematic need for suturing. A restrictive use of episiotomy increases the rate of intact perineum and of "non-severe" perineal lesions.
authors.affiliation: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Flemming, 25030 Besançon cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Chehab
authors.affiliation: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Flemming, 25030 Besançon cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Courjon
authors.affiliation: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Flemming, 25030 Besançon cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Eckman-Lacroix
authors.affiliation: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Flemming, 25030 Besançon cedex, France.
authors.forename: R
authors.initials: R
authors.lastname: Ramanah
authors.affiliation: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Flemming, 25030 Besançon cedex, France.
authors.forename: R
authors.initials: R
authors.lastname: Maillet
authors.affiliation: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Flemming, 25030 Besançon cedex, France. Electronic address: didier.riethmuller@univ-fcomte.fr.
authors.forename: D
authors.initials: D
authors.lastname: Riethmuller
mesh_terms: D000293:Adolescent; D000328:Adult; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000453:epidemiology* / Q000517:prevention & control; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
keywords: Decrease; Diminution; Déchirures périnéales; Episiotomy rate; Intact perineum; Perineal lesions; Périnée intact; Restrictive use; Taux d’épisiotomie; Utilisation restrictive