Literature is contradictory about the impact of mediolateral episiotomy during operative vaginal delivery in obstetric anal sphincter injuries prevention explaining the absence of international guidelines. The investigators consider that a randomized trials does not appears feasible for both ethical and practical reason and so we suggest a large national observational study. The investigators will include all nulliparous women that underwent an operative vaginal delivery within the 72h following the delivery at more than 34 weeks of amenorrhea. The investigators will collect data about the history of pregnancy, the course of labor, the mode of delivery, maternal immediate and one-year morbidity, neonatal immediate morbidity. The investigators expect a one-year study in 129 recruiting center with 15000 included women. The primary objective is to assess the protective effect of mediolateral episiotomy against obstetric anal sphincter injury during instrumental delivery in nulliparous women according to the type of instrument used. The secondary endpoints are to investigate the effect of mediolateral episiotomy on one-year maternal morbidity, immediate maternal morbidity. The investigators also aim to develop a clinical score to assess the absolute risk of obstetric anal sphincter injury during instrumental delivery. Finally, the investigators will investigate the impact of fetal presentation ultrasound assessment immediately before instrumental delivery on the mode of delivery.
Study Type
OBSERVATIONAL
Enrollment
15,000
Cutting of the perineum during vaginal delivery in order to avoid obstetric anal sphincter injury
Poitiers University Hospital
Poitiers, France
RECRUITINGObstetric Anal Sphincter Injury (mediolateral episiotomy vs no episiotomy for each type of instrument)
Perineal tears involving the anal sphincter complex (3rd and 4th degree according RCOG OMS classification)
Time frame: Immediately after the delivery
Immediate maternal morbidity (mediolateral episiotomy vs no episiotomy)
post partum hemorrhage, perineal infection, perineal hematoma, perineal pain, difficulty for voiding, satisfaction about childbirth, intensive care admission, death
Time frame: through mother's hospitalization, an average of 4 days
Immediate neonatal morbidity (mediolateral episiotomy versus no episiotomy)
Clinical vitality status, neonatal cephalic marks , neonatal bone fractures, admission into intensive unit care, death
Time frame: through mother's hospitalization, an average of 4 days
One year maternal morbidity (mediolateral episiotomy versus no episiotomy)
Anal incontinence, urinary incontinence, perineal pain, postnatal depression, sexual function, self rated health
Time frame: 1 year
Association between fetal presentation assessment before the delivery and the issue of delivery (ultrasound assessment versus no ultrasound assessment)
Failed instrumental delivery defined as a requirement of several instrument and/or requirement of cesarean section
Time frame: through mother's hospitalization, an average of 4 days
Development of a clinical score to assess the absolute risk of obstetric anal sphincter injury during instrumental delivery (with or without mediolateral episiotomy)
We will report the sensitivity, specificity and area under the curve of this score.
Time frame: through mother's hospitalization, an average of 4 days
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