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Impact of a selective use of episiotomy combined with Couder’s maneuver for the perineal protection

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the impact of a selective use of episiotomy combined with Couder’s maneuver on the incidence of perineal tears in spontaneous term deliveries.

Methods

A comparative, retrospective, mono-centric study in a university maternity unit was designed and included all primiparous women who delivered spontaneously after 37 weeks of gestation in cephalic presentation. Two cohorts were studied, before and after the practice of Couder’s maneuver. In the first cohort, the ''OSE cohort'' only selective episiotomies were performed from January 2009 to December 2010. In the second cohort, from January 2016 to December 2017, the ''SEC cohort'' selective episiotomies combined with Couder’s maneuver were performed by midwives and obstetricians. The primary outcome was the type of perineal tears, according to the Royal College of Obstetricians and Gynaecologists (RCOG) classification.

Results

A total of 2081 patients were included: 909 patients in the OSE cohort and 1172 patients in the SEC cohort. Couder’s maneuver was performed in 59% of the SEC cohort. In the SEC cohort, there were an increase in the number of intact perinea (55% versus 63%, p < 0.001), a decrease in second-degree perineal tears (18% versus 11%, p < 0.001) and a decrease in labia minora tears (48% versus 37%, p < 0.001). The rate of obstetrical anal sphincter injuries was less than 1% in both cohorts (0.3% versus 0.5%, p = 0.7).

Conclusion

A selective use of episiotomy combined with Couder’s maneuver could reduce the incidence of perineal tears, particularly second-degree perineal tears, without increasing the rate of obstetrical anal sphincter injuries.

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Authors and Affiliations

Authors

Contributions

ABM, AEL and DR had the idea for the original cohort study and, with PLF, ML, RR and NM carried out the design of the study. PLF collected the data. PLF, ABM, ML and NM analysed/interpreted the data and produced the first draft. PLF and ML carried out statistical analysis. All authors read, revised and approved the submitted version of the manuscript.

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Correspondence to Nicolas Mottet.

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Forey, PL., Lallemant, M., Bourtembourg-Matras, A. et al. Impact of a selective use of episiotomy combined with Couder’s maneuver for the perineal protection. Arch Gynecol Obstet 302, 77–83 (2020). https://doi.org/10.1007/s00404-020-05572-9

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  • DOI: https://doi.org/10.1007/s00404-020-05572-9

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