title: [Influence of a major decrease in the use of episiotomy applied to a high risk perineal situation: Occiput posterior presentation].
abstract: OBJECTIVE
  Occiput-posterior presentation represents 5% of all deliveries and is a high-risk situation for perineal tears requiring, for some authors, an episiotomy. The aim of this study was to evaluate the impact of an ultra-restrictive policy in the use of episiotomy on perineal tears in this high-risk situation.
  
  
  METHODS
  This is a retrospective cohort study in a tertiary maternity comparing perineal outcome of occipito-posterior (OP) to occipito-anterior deliveries. We included all, spontaneous or assisted, live single pregnancies that delivered after 37 weeks in OP from January 2008 to December 2012. This group was then compared to a control group of occipito-anterior pregnancies.
  
  
  RESULTS
  Episiotomy rate was similar in both groups (1.3 versus 1.8 in OP; p=0.5). We found more second degree perineal tears in the OP group (p<0.001) but severe perineal tears rate was similar. There was no increase in post-partum haemorrhage rate. Neonatal outcome was less favourable in the OP group.
  
  
  CONCLUSIONS
  A restrictive use of episiotomy in OP does not increase the risk of severe perineal tears and does not worsen perineal prognosis.
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors: C
authors: C
authors: Toubin
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors: N
authors: N
authors: Mottet
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors: M
authors: M
authors: Chehab
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors: M
authors: M
authors: Maurice
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors: R
authors: R
authors: Ramanah
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France. Electronic address: didier.riethmuller@univ-fcomte.fr.
authors: D
authors: D
authors: Riethmuller
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007746:Labor Presentation; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Decrease; Déchirure périnéale; Episiotomy; Occipito-sacré; Occiput posterior; Perineal lesion; Restrictive use; Utilisation restrictive; Épisiotomie