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Database - (CIANE)

Description of this bibliographical database (CIANE website)
Currently 3111 records
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https://ciane.net/id=2738

Created on : 20 Aug 2017
Modified on : 20 Aug 2017

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Bibliographical entry (without author) :

Prise en charge des périnées complets (déchirure périnéale stade 3 et 4) : revue de la littérature - Journal de Gynécologie Obstétrique et Biologie de la Reproduction - Vol. 44, 9 - ISBN: 0368-2315 - p.802-811

Author(s) :

Villot, A.; Deffieux, X.; Demoulin, G.; Rivain, A. -L.; Trichot, C.; Thubert, T.

Year of publication :

2015

URL(s) :

http://www.sciencedirect.com/science/article/pii/S…
https://doi.org/10.1016/j.jgyn.2015.06.005

Résumé (français)  :

Abstract (English)  :

Il s’agit d’une revue de la littérature réalisée sur Pubmed, Medline, Embase et Cochrane dont le but était de faire un état des lieux sur la prévalence des périnées complets, leurs facteurs de risque, leur prise en charge et pronostic fonctionnel. La prévalence des lésions périnéales du 3e et 4e degrés varie selon les études de 2,95 % quelle que soit la parité à 25 % chez les nullipares. Vingt-huit pour cent à 48 % de ces lésions sont occultes. Les facteurs de risque en analyse multivariée étaient : le forceps (OR 6,021 [IC 95 % 1,23–19,45]), la nulliparité (OR 9,8 [IC 95 % 3,6–26,2]), l’âge gestationnel supérieur à 42 SA (OR 2,5 [IC 95 % 1–6,2]), la pression du fond utérin lors de la poussée (OR 4,6 [IC 95 % 2,3–7,9]), l’épisiotomie médiane (OR 5,5 [IC 95 % 1,4–18,7]) ou encore le poids de naissance (OR 1,3 [IC 95 % 1,1–1,6]). Il n’existait pas de différence entre les deux techniques de réparation sphinctérienne. Le traitement laxatif a montré un intérêt dans le post-partum immédiat. Les données concernant l’intérêt de la rééducation sont contradictoires. Le pronostic fonctionnel après réparation montre un taux d’incontinence anale à 6 mois du post-partum de 3,6 % (stade 3) à 30,8 % (stade 4). À 30 ans la prévalence de l’incontinence fécale secondaire atteint 6,9 %.
This was a comprehensive literature review using Pubmed, Medline, Embase and Cochrane, whose aim was to analyse the prevalence of anal sphincter injuries, their risk factors, their management and their functional prognosis. The prevalence of 3rd and 4th degree perineal tears varies between studies from 2.95% regardless the parity to 25% in nulliparous women. Twenty-eight percent to 48% of these lacerations were clinically occult. Perineal tears were associated with (multivariate analysis) forceps (6.021 [IC 95% 1.23–19.45]), nulliparity (OR 9.8 [IC 95% 3.6–26.2]), gestational age over 42 SA (OR 2.5 [IC 95% 1–6.2]), fundal pressure (OR 4.6 [IC 95% 2.3–7.9]), midline episiotomy (OR 5.5 [IC 95% 1.4–18.7]) or fetal weight in interval of 250g (OR 1.3 [IC 95% 1.1–1.6]). There was no difference between the sphincter repair techniques. Post-partum laxative use showed less painful bowel motion and earlier postnatal discharge. Data concerning rehabilitation were contradictory. The rate of anal incontinence 6 months after vaginal delivery were 3.6% following third degree of perineal tear and 30.8% in case of fourth degree of perineal tear. Thirty years after anal sphincter disruption, the prevalence of fecal incontinence reached 6.9%.

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Keywords :

➡ incontinence/prolapsus ; perineal/vaginal tears

Author of this record :

Import 20/08/2017 — 20 Aug 2017

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This database created by Alliance francophone pour l'accouchement respecté (AFAR) is managed
by Collectif interassociatif autour de la naissance (CIANE, https://ciane.net).
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