부산대학교 도서관

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1471-0528.2008.01960.x Byline: DJ Murphy (a), M Macleod (b), R Bahl (c), K Goyder (c), L Howarth (c), B Strachan (c) Keywords: Anal sphincter tears; episiotomy; operative vaginal delivery; randomised controlled trial Abstract: Objective To compare the maternal and neonatal outcomes of operative vaginal delivery in relation to the use of episiotomy. Design Pilot randomised controlled trial (RCT). Setting Two urban maternity units in Scotland and England. Sample Nulliparous women anticipating a singleton cephalic vaginal delivery were recruited in the antenatal period. Methods If an operative vaginal delivery was required in the second stage of labour, women were randomised to either routine (in all cases) or restrictive (only if tearing apparent) use of episiotomy. Main outcome measures The primary outcome was anal sphincter tearing (third or fourth degree). Secondary outcomes included postpartum haemorrhage (PPH), neonatal trauma and pelvic floor symptoms up until 10 days postpartum. Results In a group of 317 women requiring operative vaginal delivery, 200 were randomised: 99 to routine use of episiotomy and 101 to restrictive use. There were small differences in the rates of anal sphincter tears (8.1% routine versus 10.9% restrictive, OR 0.72, 95% CI 0.28-1.87) and primary PPH (36.4% routine versus 26.7% restrictive, OR 1.57, 95% CI 0.86-2.86). Neonatal trauma was similar between the two groups (45.5% routine versus 43.6% restrictive, OR 1.08, 95% CI 0.62-1.89), as was prolonged catheterisation, urinary incontinence, faecal incontinence, perineal infection and prolonged hospital admission. Conclusions This pilot study does not provide conclusive evidence that a policy of routine episiotomy is better or worse than a restrictive policy. A definitive RCT is feasible but will require a large sample size to inform clinical practice. Author Affiliation: (a )Academic Department of Obstetrics and Gynaecology, Coombe Women's Hospital, Trinity College, University of Dublin, Dublin, Ireland (b )Division of Maternal and Child Health Sciences, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK (c )St Michael's Hospital, Bristol, UK Article History: Accepted 13 July 2008. Article note: Prof DJ Murphy, Academic Department of Obstetrics and Gynaecology, Coombe Women's Hospital, Trinity College, University of Dublin, Dublin 8, Ireland. Email deirdre.j.murphy@tcd.ie