Restrictive versus routine episiotomy among Southeast Asian term pregnancies: a multicentre randomised controlled trial
Objective To determine whether restrictive or routine episiotomy in term pregnant Southeast Asian women results in fewer complications. Design A multicentre randomised controlled trial. Setting Two tertiary and two general hospitals in Thailand. Population 3006 singleton pregnant women 18 years or o...
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| Veröffentlicht in: | BJOG : an international journal of obstetrics and gynaecology 2020-02, Vol.127 (3), p.397-403 |
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| container_title | BJOG : an international journal of obstetrics and gynaecology |
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| creator | Sangkomkamhang, U Kongwattanakul, K Kietpeerakool, C Thinkhamrop, J Wannasiri, P Khunpradit, S Thepsuthamarat, K Jampathong, N Lumbiganon, P |
| description | Objective
To determine whether restrictive or routine episiotomy in term pregnant Southeast Asian women results in fewer complications.
Design
A multicentre randomised controlled trial.
Setting
Two tertiary and two general hospitals in Thailand.
Population
3006 singleton pregnant women 18 years or older, ≥37 weeks of gestation, cephalic presentation and planned vaginal delivery.
Methods
This randomised controlled trial compared routine versus restrictive episiotomies in Thai women giving birth vaginally. Participants were singleton, term pregnant women with cephalic presentation. Block randomisation was stratified by study site and parity. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to indicate between‐group differences.
Main outcome measures
Primary outcome was severe perineal laceration. Secondary outcomes included vaginal laceration, cervical laceration, and pregnancy outcomes.
Results
3006 women were randomly assigned to restrictive (1502) and routine (1504) episiotomy. There was no difference in severe perineal laceration between the groups (RR 0.72, 95% CI 0.46–1.12). Restrictive episiotomy resulted in more intact perineums in multiparous women (RR 3.09, 95% CI 2.10–4.56). Restrictive episiotomy increased the risk of vaginal laceration in primiparous (RR 1.96, 95% CI 1.62–2.37) and multiparous women (RR 2.21, 95% CI 1.77–2.75) but did not lead to more suturing. There were comparable risks of cervical laceration, postpartum haemorrhage, wound complication, birth asphyxia, and admission to neonatal intensive care unit.
Conclusions
Restrictive episiotomy results in more intact perineum in multiparous women. Risks of maternal and neonatal outcomes were comparable between the two practices. These results strengthen the certainty of the existing Cochrane review findings in supporting restrictive episiotomy.
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Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women.
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Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women. |
| doi_str_mv | 10.1111/1471-0528.15982 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2316778872</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2316778872</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3712-243fca7a416f80af77ee15f12e3b205b64c0cfd165df2743cd4f62071677c2363</originalsourceid><addsrcrecordid>eNqFkbtPwzAQxi0EolCY2ZAlFpaAH0mcsgHiKSQkHrPlOufiKrGLnYD63-M-6MDCLT6df_fdnT6Ejig5oynOaS5oRgpWndFiVLEttLepbC9zkhHOqgHaj3FKCC0Z4btowKnIR0zwPfT9ArELVnf2C_AXhNhHHHzfWQcYZjZa3_l2jlXr3QS_po8PULHDl9EqhzsILZ4FmDjltIV4gRVu-6azGlwXAAflat_aCDXWPlV806Q0jVPNAdoxqolwuH6H6P325u36Pnt6vnu4vnzKNBeUZSznRiuhclqaiigjBAAtDGXAx4wU4zLXRJualkVtmMi5rnOTbhS0FEIzXvIhOl3pzoL_7NOtMu2joWmUA99HyfgCrSrBEnryB536Pri0XaJ4QkROaKLOV5QOPsYARs6CbVWYS0rkwhO5cEAuHJBLT1LH8Vq3H7dQb_hfExJQrIBv28D8Pz159fi8Ev4B112XmQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2338877401</pqid></control><display><type>article</type><title>Restrictive versus routine episiotomy among Southeast Asian term pregnancies: a multicentre randomised controlled trial</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Sangkomkamhang, U ; Kongwattanakul, K ; Kietpeerakool, C ; Thinkhamrop, J ; Wannasiri, P ; Khunpradit, S ; Thepsuthamarat, K ; Jampathong, N ; Lumbiganon, P</creator><creatorcontrib>Sangkomkamhang, U ; Kongwattanakul, K ; Kietpeerakool, C ; Thinkhamrop, J ; Wannasiri, P ; Khunpradit, S ; Thepsuthamarat, K ; Jampathong, N ; Lumbiganon, P</creatorcontrib><description>Objective
To determine whether restrictive or routine episiotomy in term pregnant Southeast Asian women results in fewer complications.
Design
A multicentre randomised controlled trial.
Setting
Two tertiary and two general hospitals in Thailand.
Population
3006 singleton pregnant women 18 years or older, ≥37 weeks of gestation, cephalic presentation and planned vaginal delivery.
Methods
This randomised controlled trial compared routine versus restrictive episiotomies in Thai women giving birth vaginally. Participants were singleton, term pregnant women with cephalic presentation. Block randomisation was stratified by study site and parity. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to indicate between‐group differences.
Main outcome measures
Primary outcome was severe perineal laceration. Secondary outcomes included vaginal laceration, cervical laceration, and pregnancy outcomes.
Results
3006 women were randomly assigned to restrictive (1502) and routine (1504) episiotomy. There was no difference in severe perineal laceration between the groups (RR 0.72, 95% CI 0.46–1.12). Restrictive episiotomy resulted in more intact perineums in multiparous women (RR 3.09, 95% CI 2.10–4.56). Restrictive episiotomy increased the risk of vaginal laceration in primiparous (RR 1.96, 95% CI 1.62–2.37) and multiparous women (RR 2.21, 95% CI 1.77–2.75) but did not lead to more suturing. There were comparable risks of cervical laceration, postpartum haemorrhage, wound complication, birth asphyxia, and admission to neonatal intensive care unit.
Conclusions
Restrictive episiotomy results in more intact perineum in multiparous women. Risks of maternal and neonatal outcomes were comparable between the two practices. These results strengthen the certainty of the existing Cochrane review findings in supporting restrictive episiotomy.
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Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women.
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Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women.</description><identifier>ISSN: 1470-0328</identifier><identifier>EISSN: 1471-0528</identifier><identifier>DOI: 10.1111/1471-0528.15982</identifier><identifier>PMID: 31749273</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Asian women ; Asphyxia ; Birth ; Childbirth & labor ; Delivery, Obstetric - adverse effects ; Delivery, Obstetric - methods ; episiotomy ; Episiotomy - adverse effects ; Episiotomy - methods ; Female ; Gestation ; Hemorrhage ; Humans ; Intraoperative Complications - diagnosis ; Intraoperative Complications - prevention & control ; Labor Presentation ; Lacerations - diagnosis ; Lacerations - etiology ; Lacerations - prevention & control ; Neonates ; Parity ; Perineum ; Perineum - injuries ; Postpartum ; Pregnancy ; Pregnancy complications ; Pregnancy Outcome - epidemiology ; restrictive ; Risk Adjustment - methods ; routine ; Term Birth ; Thailand ; Vagina ; vaginal birth ; Womens health</subject><ispartof>BJOG : an international journal of obstetrics and gynaecology, 2020-02, Vol.127 (3), p.397-403</ispartof><rights>2019 Royal College of Obstetricians and Gynaecologists</rights><rights>2019 Royal College of Obstetricians and Gynaecologists.</rights><rights>Copyright © 2020 Royal College of Obstetricians and Gynaecologists</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3712-243fca7a416f80af77ee15f12e3b205b64c0cfd165df2743cd4f62071677c2363</citedby><cites>FETCH-LOGICAL-c3712-243fca7a416f80af77ee15f12e3b205b64c0cfd165df2743cd4f62071677c2363</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2F1471-0528.15982$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2F1471-0528.15982$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31749273$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sangkomkamhang, U</creatorcontrib><creatorcontrib>Kongwattanakul, K</creatorcontrib><creatorcontrib>Kietpeerakool, C</creatorcontrib><creatorcontrib>Thinkhamrop, J</creatorcontrib><creatorcontrib>Wannasiri, P</creatorcontrib><creatorcontrib>Khunpradit, S</creatorcontrib><creatorcontrib>Thepsuthamarat, K</creatorcontrib><creatorcontrib>Jampathong, N</creatorcontrib><creatorcontrib>Lumbiganon, P</creatorcontrib><title>Restrictive versus routine episiotomy among Southeast Asian term pregnancies: a multicentre randomised controlled trial</title><title>BJOG : an international journal of obstetrics and gynaecology</title><addtitle>BJOG</addtitle><description>Objective
To determine whether restrictive or routine episiotomy in term pregnant Southeast Asian women results in fewer complications.
Design
A multicentre randomised controlled trial.
Setting
Two tertiary and two general hospitals in Thailand.
Population
3006 singleton pregnant women 18 years or older, ≥37 weeks of gestation, cephalic presentation and planned vaginal delivery.
Methods
This randomised controlled trial compared routine versus restrictive episiotomies in Thai women giving birth vaginally. Participants were singleton, term pregnant women with cephalic presentation. Block randomisation was stratified by study site and parity. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to indicate between‐group differences.
Main outcome measures
Primary outcome was severe perineal laceration. Secondary outcomes included vaginal laceration, cervical laceration, and pregnancy outcomes.
Results
3006 women were randomly assigned to restrictive (1502) and routine (1504) episiotomy. There was no difference in severe perineal laceration between the groups (RR 0.72, 95% CI 0.46–1.12). Restrictive episiotomy resulted in more intact perineums in multiparous women (RR 3.09, 95% CI 2.10–4.56). Restrictive episiotomy increased the risk of vaginal laceration in primiparous (RR 1.96, 95% CI 1.62–2.37) and multiparous women (RR 2.21, 95% CI 1.77–2.75) but did not lead to more suturing. There were comparable risks of cervical laceration, postpartum haemorrhage, wound complication, birth asphyxia, and admission to neonatal intensive care unit.
Conclusions
Restrictive episiotomy results in more intact perineum in multiparous women. Risks of maternal and neonatal outcomes were comparable between the two practices. These results strengthen the certainty of the existing Cochrane review findings in supporting restrictive episiotomy.
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Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women.
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Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women.</description><subject>Adult</subject><subject>Asian women</subject><subject>Asphyxia</subject><subject>Birth</subject><subject>Childbirth & labor</subject><subject>Delivery, Obstetric - adverse effects</subject><subject>Delivery, Obstetric - methods</subject><subject>episiotomy</subject><subject>Episiotomy - adverse effects</subject><subject>Episiotomy - methods</subject><subject>Female</subject><subject>Gestation</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Intraoperative Complications - diagnosis</subject><subject>Intraoperative Complications - prevention & control</subject><subject>Labor Presentation</subject><subject>Lacerations - diagnosis</subject><subject>Lacerations - etiology</subject><subject>Lacerations - prevention & control</subject><subject>Neonates</subject><subject>Parity</subject><subject>Perineum</subject><subject>Perineum - injuries</subject><subject>Postpartum</subject><subject>Pregnancy</subject><subject>Pregnancy complications</subject><subject>Pregnancy Outcome - epidemiology</subject><subject>restrictive</subject><subject>Risk Adjustment - methods</subject><subject>routine</subject><subject>Term Birth</subject><subject>Thailand</subject><subject>Vagina</subject><subject>vaginal birth</subject><subject>Womens health</subject><issn>1470-0328</issn><issn>1471-0528</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkbtPwzAQxi0EolCY2ZAlFpaAH0mcsgHiKSQkHrPlOufiKrGLnYD63-M-6MDCLT6df_fdnT6Ejig5oynOaS5oRgpWndFiVLEttLepbC9zkhHOqgHaj3FKCC0Z4btowKnIR0zwPfT9ArELVnf2C_AXhNhHHHzfWQcYZjZa3_l2jlXr3QS_po8PULHDl9EqhzsILZ4FmDjltIV4gRVu-6azGlwXAAflat_aCDXWPlV806Q0jVPNAdoxqolwuH6H6P325u36Pnt6vnu4vnzKNBeUZSznRiuhclqaiigjBAAtDGXAx4wU4zLXRJualkVtmMi5rnOTbhS0FEIzXvIhOl3pzoL_7NOtMu2joWmUA99HyfgCrSrBEnryB536Pri0XaJ4QkROaKLOV5QOPsYARs6CbVWYS0rkwhO5cEAuHJBLT1LH8Vq3H7dQb_hfExJQrIBv28D8Pz159fi8Ev4B112XmQ</recordid><startdate>202002</startdate><enddate>202002</enddate><creator>Sangkomkamhang, U</creator><creator>Kongwattanakul, K</creator><creator>Kietpeerakool, C</creator><creator>Thinkhamrop, J</creator><creator>Wannasiri, P</creator><creator>Khunpradit, S</creator><creator>Thepsuthamarat, K</creator><creator>Jampathong, N</creator><creator>Lumbiganon, P</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>202002</creationdate><title>Restrictive versus routine episiotomy among Southeast Asian term pregnancies: a multicentre randomised controlled trial</title><author>Sangkomkamhang, U ; Kongwattanakul, K ; Kietpeerakool, C ; Thinkhamrop, J ; Wannasiri, P ; Khunpradit, S ; Thepsuthamarat, K ; Jampathong, N ; Lumbiganon, P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3712-243fca7a416f80af77ee15f12e3b205b64c0cfd165df2743cd4f62071677c2363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Asian women</topic><topic>Asphyxia</topic><topic>Birth</topic><topic>Childbirth & labor</topic><topic>Delivery, Obstetric - adverse effects</topic><topic>Delivery, Obstetric - methods</topic><topic>episiotomy</topic><topic>Episiotomy - adverse effects</topic><topic>Episiotomy - methods</topic><topic>Female</topic><topic>Gestation</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Intraoperative Complications - diagnosis</topic><topic>Intraoperative Complications - prevention & control</topic><topic>Labor Presentation</topic><topic>Lacerations - diagnosis</topic><topic>Lacerations - etiology</topic><topic>Lacerations - prevention & control</topic><topic>Neonates</topic><topic>Parity</topic><topic>Perineum</topic><topic>Perineum - injuries</topic><topic>Postpartum</topic><topic>Pregnancy</topic><topic>Pregnancy complications</topic><topic>Pregnancy Outcome - epidemiology</topic><topic>restrictive</topic><topic>Risk Adjustment - methods</topic><topic>routine</topic><topic>Term Birth</topic><topic>Thailand</topic><topic>Vagina</topic><topic>vaginal birth</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sangkomkamhang, U</creatorcontrib><creatorcontrib>Kongwattanakul, K</creatorcontrib><creatorcontrib>Kietpeerakool, C</creatorcontrib><creatorcontrib>Thinkhamrop, J</creatorcontrib><creatorcontrib>Wannasiri, P</creatorcontrib><creatorcontrib>Khunpradit, S</creatorcontrib><creatorcontrib>Thepsuthamarat, K</creatorcontrib><creatorcontrib>Jampathong, N</creatorcontrib><creatorcontrib>Lumbiganon, P</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sangkomkamhang, U</au><au>Kongwattanakul, K</au><au>Kietpeerakool, C</au><au>Thinkhamrop, J</au><au>Wannasiri, P</au><au>Khunpradit, S</au><au>Thepsuthamarat, K</au><au>Jampathong, N</au><au>Lumbiganon, P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Restrictive versus routine episiotomy among Southeast Asian term pregnancies: a multicentre randomised controlled trial</atitle><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle><addtitle>BJOG</addtitle><date>2020-02</date><risdate>2020</risdate><volume>127</volume><issue>3</issue><spage>397</spage><epage>403</epage><pages>397-403</pages><issn>1470-0328</issn><eissn>1471-0528</eissn><abstract>Objective
To determine whether restrictive or routine episiotomy in term pregnant Southeast Asian women results in fewer complications.
Design
A multicentre randomised controlled trial.
Setting
Two tertiary and two general hospitals in Thailand.
Population
3006 singleton pregnant women 18 years or older, ≥37 weeks of gestation, cephalic presentation and planned vaginal delivery.
Methods
This randomised controlled trial compared routine versus restrictive episiotomies in Thai women giving birth vaginally. Participants were singleton, term pregnant women with cephalic presentation. Block randomisation was stratified by study site and parity. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to indicate between‐group differences.
Main outcome measures
Primary outcome was severe perineal laceration. Secondary outcomes included vaginal laceration, cervical laceration, and pregnancy outcomes.
Results
3006 women were randomly assigned to restrictive (1502) and routine (1504) episiotomy. There was no difference in severe perineal laceration between the groups (RR 0.72, 95% CI 0.46–1.12). Restrictive episiotomy resulted in more intact perineums in multiparous women (RR 3.09, 95% CI 2.10–4.56). Restrictive episiotomy increased the risk of vaginal laceration in primiparous (RR 1.96, 95% CI 1.62–2.37) and multiparous women (RR 2.21, 95% CI 1.77–2.75) but did not lead to more suturing. There were comparable risks of cervical laceration, postpartum haemorrhage, wound complication, birth asphyxia, and admission to neonatal intensive care unit.
Conclusions
Restrictive episiotomy results in more intact perineum in multiparous women. Risks of maternal and neonatal outcomes were comparable between the two practices. These results strengthen the certainty of the existing Cochrane review findings in supporting restrictive episiotomy.
Tweetable
Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women.
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Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31749273</pmid><doi>10.1111/1471-0528.15982</doi><tpages>7</tpages></addata></record> |
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| identifier | ISSN: 1470-0328 |
| ispartof | BJOG : an international journal of obstetrics and gynaecology, 2020-02, Vol.127 (3), p.397-403 |
| issn | 1470-0328 1471-0528 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2316778872 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Asian women Asphyxia Birth Childbirth & labor Delivery, Obstetric - adverse effects Delivery, Obstetric - methods episiotomy Episiotomy - adverse effects Episiotomy - methods Female Gestation Hemorrhage Humans Intraoperative Complications - diagnosis Intraoperative Complications - prevention & control Labor Presentation Lacerations - diagnosis Lacerations - etiology Lacerations - prevention & control Neonates Parity Perineum Perineum - injuries Postpartum Pregnancy Pregnancy complications Pregnancy Outcome - epidemiology restrictive Risk Adjustment - methods routine Term Birth Thailand Vagina vaginal birth Womens health |
| title | Restrictive versus routine episiotomy among Southeast Asian term pregnancies: a multicentre randomised controlled trial |
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