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Créée le : 05 May 2005
Modifiée le : 02 Dec 2007

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Notice bibliographique (sans auteurs) :

The Use of Episiotomy in Obstetrical Care: A Systematic Review. Evidence Report/Technology Assessment: Number 112. Agency for Healthcare Research and Quality

Auteur·e(s) :

Viswanathan M, Hartmann K, Palmieri R, Lux L, Swinson T, Lohr KN, Gartlehner G, Thorp J Jr.

Année de publication :

2005

URL(s) :

http://www.ahrq.gov/clinic/tp/epistp.htm

Résumé (français)  :

Abstract (English)  :

Our systematic review finds no health benefits from episiotomy. We found fair to good evidence suggesting that the immediate outcomes for routine (liberal-use policies) episiotomy are no better than those for indicated use of episiotomy under more restrictive-use policies. Indeed, routine use is harmful to the degree that it creates a surgical incision of greater extent than many women might have experienced had episiotomy not been performed. Weak trial evidence, consistent with observational data, suggests that the harms of midline episiotomy are greater than the harms of mediolateral episiotomy.

For episiotomy repair, fair to good evidence, albeit across different comparisons of methods and materials, suggests that leaving the perineal skin unsutured may confer some benefit; if suturing is indicated, then a continuous, subcuticular method is better than an interrupted, transcutaneous method. Regarding suture material, the evidence is consistent and clear that absorbable sutures are preferred and that polyglycolic-acid sutures have significantly less perineal morbidity associated with them. Newer materials, such as tissue adhesive, may offer further benefits, but the data are at present wholly inadequate to inform care practices.

The level of evidence for long-term sequelae, specifically fecal and urinary incontinence, pelvic floor function, and future sexual function, is fair to poor. Nonetheless, it is consistent in demonstrating the lack of benefit of the procedure in a comparatively early timeframe. For women in later adult life, when morbidity is most likely to occur in the form of severe and persistent incontinence or pelvic organ prolapse, the expected results of routine episiotomy are unknown.

Sumário (português)  :

Resumen (español)  :

Remarques :

Le rapport en texte intégral est téléchargeable depuis cette page.

Argument (français) :

Notre revue systématique des études médicales conclut à l’absence d’intérêt de l’épisiotomie. / Our systematic review finds no health benefits from episiotomy.

Argument (English):

Our systematic review finds no health benefits from episiotomy.

Argumento (português):

Argumento (español):

Mots-clés :

➡ déchirures ; incontinence/prolapsus ; épisiotomie ; morbidité

Auteur·e de cette fiche :

Bernard Bel — 05 May 2005