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Journal ArticleDOI

Postpartum observation of pelvic tissue damage: further studies.

01 Oct 1955-American Journal of Obstetrics and Gynecology (Am J Obstet Gynecol)-Vol. 70, Iss: 4, pp 800-807
About: This article is published in American Journal of Obstetrics and Gynecology.The article was published on 1955-10-01. It has received 66 citations till now. The article focuses on the topics: Postpartum period & Obstetric labor complication.
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Reference EntryDOI
TL;DR: Restrictive episiotomy policies appear to have a number of benefits compared to routine episiotome policies, and there was an increased risk of anterior perineal trauma with restrictive episiotomies.
Abstract: Background Episiotomy is done to prevent severe perineal tears, but its routine use has been questioned. The relative effects of midline compared with midlateral episiotomy are unclear. Objectives The objective of this review was to assess the effects of restrictive use of episiotomy compared with routine episiotomy during vaginal birth. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2008). Selection criteria Randomized trials comparing restrictive use of episiotomy with routine use of episiotomy; restrictive use of mediolateral episiotomy versus routine mediolateral episiotomy; restrictive use of midline episiotomy versus routine midline episiotomy; and use of midline episiotomy versus mediolateral episiotomy. Data collection and analysis The two review authors independently assessed trial quality and extracted the data. Main results We included eight studies (5541 women). In the routine episiotomy group, 75.15% (2035/2708) of women had episiotomies, while the rate in the restrictive episiotomy group was 28.40% (776/2733). Compared with routine use, restrictive episiotomy resulted in less severe perineal trauma (relative risk (RR) 0.67, 95% confidence interval (CI) 0.49 to 0.91), less suturing (RR 0.71, 95% CI 0.61 to 0.81) and fewer healing complications (RR 0.69, 95% CI 0.56 to 0.85). Restrictive episiotomy was associated with more anterior perineal trauma (RR 1.84, 95% CI 1.61 to 2.10). There was no difference in severe vaginal/perineal trauma (RR 0.92, 95% CI 0.72 to 1.18); dyspareunia (RR 1.02, 95% CI 0.90 to 1.16); urinary incontinence (RR 0.98, 95% CI 0.79 to 1.20) or several pain measures. Results for restrictive versus routine mediolateral versus midline episiotomy were similar to the overall comparison. Authors' conclusions Restrictive episiotomy policies appear to have a number of benefits compared to policies based on routine episiotomy. There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy.

722 citations

Journal ArticleDOI
TL;DR: Injuries to the levator ani muscles in women after their first vaginal delivery are associated with several obstetric factors indicating difficult vaginal birth and with older age.

429 citations

Journal ArticleDOI
TL;DR: This study was designed to define prevalence and clinical significance of morphological abnormalities of the pubovisceral muscle in urogynaecological patients.

252 citations

Journal ArticleDOI
TL;DR: The authors' multivariable results suggest that one additional woman would have development of prolapse for every eight women who experienced at least one forceps birth (compared with delivering all her children by spontaneous vaginal birth).

189 citations

Journal ArticleDOI
TL;DR: The bladder neck was significantly lower at rest in women after vaginal delivery than in those who had an elective cesarean delivery and in nulligravid controls, and the ability of the pelvic muscles to elevate the urethra in some women was reduced.

187 citations

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Journal ArticleDOI
TL;DR: A method employed recording in an anatomical order pelvic tissue damage due to parturition is presented with a preliminary report of figures showing damage to the various planes and regions, and antagonists of either procedure need more detailed and objective evidence.

102 citations