Feasibility study of conducting routine episiotomy on primigravidas
Abstract
Objective: To study the role of routine protective episiotomy in reducing perineal tears and haemorrhage during childbirth and in shortening the time to the second stage of labour and neonatal outcome.
Methods: The research sample included 50 pregnant women aged (14-36) who attended the Department of Obstetrics and Gynecology at Tishreen University Hospital in Lattakia during the time period 2021-2022.
The woman was admitted to the labor department. The clinical evaluation of the patient included:Taking a detailed clinical history and documenting the following information: (parental age - date of the last menstrual period (gestational age) - gestational antecedents - congenital antecedents - pathological antecedents - surgical antecedents).Conducting a thorough clinical examination and documenting the following information: (the patient's vital signs - confirmation of labor (uterine contractions) - gynecological examination). The evaluation included an ultrasound (fetal evaluation and determination of the type of presentation - fetal weight ). After making sure that the patient met the admission and exclusion criteria, the woman's voluntary consent was taken to enter the study, and then all the women were followed up during labor and delivery and up to two hours after delivery, where we did the following: Calculating the the second stage of labour time, Assessment of the presence and degree of spontaneous perineal tears,Estimate the amount of total bleeding during the first two hours of delivery. After that, we recorded the newborn Apgar score (first minute), And then the questionnaire assigned to the study was filled out for each patient, after which we analyzed and tabulated the data and extracted the results.
Results: The current study showed that 63.6% of the primates of the restrictive episiotomy group were seen in the primates of the restrictive episiotomy group, compared to 56% in the routine episiotomy group who underwent episiotomy only without any other spontaneous tears. The results of the current study also showed that spontaneous anterior perinal laceration(vagina, labia and periurethral) It was more common in the restrictive episiotomy group (27.3% versus 16%) in the routine episiotomy group with no statistically significant difference between the two study groups, and also compared between the two groups of our study in terms of severe third-degree perineal laceration(, it was higher in the routine episiotomy group.(8% vs. 4.5%) in the restrictive episiotomy group with no statistically significant difference, and the role of the routine episiotomy was proven in shortening the duration of t the second stage of labour time, where the average duration of the second stage of labor in the routine episiotomy group was( 55.36 ±4.5min)Compared to a mean of (62.32 ±3.4 min)in the restrictive episiotomy group with a difference of about 7 minutes with a significant statistical difference, the average value of the estimated total bleeding during the first two hours of birth was higher in the routine episiotomy group (265.56 ±20.6 ml versus 238.11 ±16.4 ml) in the restricted episiotomy group. In the routine episiotomy group, blood was lost from the episiotomy incision in addition to spontaneous tears, if present. In the restricted episiotomy group, blood loss was only from spontaneous tears with a statistically significant difference. In terms of neonatal outcomes, there was no statistically significant difference in our study. Between the two research groups in terms of the condition of the newborn represented by the Apgar score in the first minute.
CONCLUSION: Promote the use of restrictive episiotomy in clinically necessary cases.
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