Episiotomy and perineal tears in lo

Episiotomy and perineal tears in low-risk
UK primigravidae
F. L R. Williams, C. du V. Florey, G. J. Mires and S. A. Ogston
Abstract
Background The aim of the study was to determine the rates
and to describe the risk factors for episiotomy and perineal
tears in low-risk primigravidae.
Method A cross-sectional survey of 101 randomly selected
NHS hospitals in the UK was carried out between February
1993 and January 1994. Subjects were 40 consecutive lowrisk
primigravidae in each hospital. The main outcome
measures were number and reasons for episiotomy, and
number and degree of perineal tears.
Results A large proportion of women (83 per cent) experienced
some form of perineal trauma. Forty per cent of the
women had an episiotomy only, 6 per cent an episiotomy
and perineal tear, and 37 per cent perineal or other tears
without episiotomy. The main reasons for performing an
episiotomy were foetal distress (27 percent), impending tear
(25 per cent) and delay of the second stage of labour (21 per
cent). Fifty-nine per cent of women with a delayed second
stage had a spontaneous vaginal delivery and 41 per cent
required instrumental assistance. The likelihood of having
an episiotomy increased with the duration of the second
stage of labour, irrespective of type of delivery. Episiotomy
rates varied appreciably throughout regions and hospitals in
the United Kingdom, ranging from 26 to 67 per cent. There
was also a large regional variation in the rates of perineal
trauma; generally, high rates of one outcome were associated
with low rates of the other. Compared with white
women, women from the Indian sub-continent were almost
twice as likely and those from the Orient almost five times as
likely to have an episiotomy.
Conclusions The magnitude of the geographical variation
suggests a lack of uniformity in indications for performing
episiotomies and that guidelines for performing episiotomies
may need to be reviewed. The rates of episiotomy
in women from the Indian sub-continent and Orient were
very high compared with those for white women, and this
requires clarification and explanation, as they are contrary to
rates experienced in these ethnic groups in other countries.
Keywords: episiotomy, low-risk primigravidae, ethnicity,
geographical variation
Introduction
Episiotomy is a commonly performed surgical procedure of
childbirth but globally the rates vary considerably. They have
been reported to occur in 83 per cent of routine primigravid
and multiparous deliveries in Argentina,1 in over 50 per cent
of hospital-based deliveries in the United States,2 and in 30 per
cent of deliveries in Sweden.3 In England and Wales the
rates increased from 25 per cent of all deliveries in 1967 to 53
per cent in 1978.4 Recent data derived from the rather patchy
returns to the Maternal Hospital Episode Statistics suggest
that the multigravid rates in England have fallen to 20 per cent
in 1994-1995.5
Some textbooks of obstetrics comment that episiotomies
will be necessary in almost all primigravidae.6 The procedure
is not routinely recommended in the United Kingdom7 and there
is controversy about how many should be performed.
The Argentine Episiotomy Trial Collaborative Group1 reported
that episiotomy rates above 30 per cent cannot be justified
for multiparae and above 40 per cent for primigravidae.
The supposed maternal benefits of episiotomy include a
reduction in third and fourth degree tears, preservation of
the muscle of the pelvic floor, and more speedy healing.8 For
the infant it is suggested that the procedure minimizes the risk
of foetal asphyxia, cranial trauma, cerebral haemorrhage and
mental retardation.7 However, there is evidence that the
maternal benefits may not be uniformly experienced and there
are reports suggesting that episiotomies may result in an
increased loss of blood,9 a higher infection rate,10 and an
increase in third- and fourth-degree lacerations."
As part of a study of intrapartum care we have investigated
perineal trauma in primigravidae in the United Kingdom. In
this paper we report the rates and describe the risk factors for
having an episiotomy and the numbers and degree of perineal
tears.

Hasil (Bahasa Indonesia) 1:

Episiotomi dan n. perineum menangis di berisiko rendahUK primigravidaeF. L R. Williams, C. du V. Florey, G. J. Mires, dan S. A. OgstonAbstrakLatar belakang tujuan studi adalah untuk menentukan hargadan untuk menggambarkan faktor risiko untuk episiotomi dan n. perineumair mata di rendah risiko primigravidae.Metode A survei penampang 101 dipilih acakRumah sakit NHS di UK dilaksanakan antara Februaritahun 1993 dan Januari 1994. Subyek adalah 40 lowrisk berturut-turutprimigravidae di rumah sakit masing-masing. Hasil utamalangkah-langkah yang jumlah dan alasan untuk episiotomi, dannomor dan gelar n. perineum air mata.Sebagian besar perempuan (83 persen) mengalami hasilbeberapa bentuk n. perineum trauma. Empat puluh persenwanita memiliki episiotomi hanya 6 persen per episiotomidan n. perineum robek, dan 37 persen n. perineum atau air mata laintanpa episiotomi. Alasan utama untuk melakukanepisiotomi adalah janin distress (27 persen), air mata akan datang(25 persen) dan menunda tahap kedua dari tenaga kerja (21 perpersen). Lima puluh sembilan persen wanita dengan kedua tertundatahap punya persalinan yang spontan dan 41 persendiperlukan bantuan instrumental. Kemungkinan memilikiepisiotomi meningkat dengan durasi keduatahap buruh, terlepas dari jenis pengiriman. Episiotomiharga bervariasi lumayan seluruh wilayah dan rumah sakit diInggris, mulai dari 26 hingga 67 persen. Adaadalah juga variasi regional besar di tingkat n. perineumtrauma; umumnya, tingginya tingkat satu hasil dikaitkandengan harga rendah yang lain. Dibandingkan dengan putihwanita, perempuan dari sub-benua India yang hampirdua kali mungkin dan orang-orang dari Timur yang hampir lima kali sebagaicenderung memiliki episiotomi.Kesimpulan besarnya variasi geografismenunjukkan kurangnya keseragaman dalam indikasi untuk melakukanepisiotomies dan bahwa pedoman untuk melakukan episiotomiesmungkin perlu untuk ditinjau. Tingkat episiotomipada wanita dari sub-benua India dan Orientsangat tinggi dibandingkan dengan orang-orang untuk wanita kulit putih, dan inimemerlukan klarifikasi dan penjelasan, karena mereka bertentanganharga yang berpengalaman dalam kelompok-kelompok etnis ini di negara lain.Kata kunci: episiotomi, rendah risiko primigravidae, etnis,variasi geografisPendahuluanEpisiotomi adalah prosedur pembedahan biasanya dilakukan darimelahirkan tapi global harga bervariasi. Mereka memilikitelah dilaporkan terjadi di 83 persen dari primigravid rutindan multiparous pengiriman di Argentina, 1 di lebih dari 50 persenberbasis rumah sakit pengiriman di Amerika Serikat, 2 dan 30 perpersen dari pengiriman di Sweden.3 di Inggris dan Walesharga meningkat dari 25 persen dari semua pengiriman di tahun 1967 sampai 53persen di 1978.4 data baru yang berasal dari agak meratakembali ke rumah sakit ibu Episode Statistik menyarankansuku multigravid di Inggris telah jatuh ke 20 persendi 1994-1995.5Beberapa buku kebidanan komentar yang episiotomiesakan diperlukan pada hampir semua primigravidae.6 prosedursecara rutin tidak dianjurkan dalam Kingdom7 Inggris dan adaadalah kontroversi tentang berapa banyak harus dilakukan.Argentina episiotomi Trial kolaboratif Group1 dilaporkanepisiotomi harga di atas 30 persen tidak dapat dibenarkanuntuk multiparae dan di atas 40 persen untuk primigravidae.Ibu seharusnya manfaat dari episiotomi meliputipenurunan tingkat ketiga dan keempat air mata, pelestarianotot panggul, dan lebih cepat healing.8 untukbayi disarankan bahwa prosedur meminimalkan risikojanin asphyxia kranial trauma, pendarahan otak danmental retardation.7 Namun, ada bukti bahwaIbu manfaat mungkin tidak seragam berpengalaman dan adalaporan menyarankan bahwa episiotomies dapat mengakibatkanpeningkatan kehilangan darah, 9 tingkat infeksi yang lebih tinggi, 10 danpeningkatan derajat ketiga dan keempat luka."Sebagai bagian dari studi intrapartum perawatan kami telah diselidikin. perineum trauma di primigravidae di Britania Raya. DalamMakalah ini kami melaporkan tingkat dan menggambarkan faktor risikoepisiotomi dan angka dan tingkat n. perineumair mata.