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Master Thesis

Le recours à l'épisiotomie : déterminants de la pratique des sages-femmes. Étude à la maternité de Port-Royal

Abstract : Episiotomy: drivers of midwives' practice. Objective: The purpose of this study is to explore maternal or fetal determinants influencing midwives on the use of episiotomy. Materials and methods: This is a single-center case-control study with two groups of patients composed of 103 primiparous and 56 second pares who delivered vaginally at term (> or = 37SA) with a live-born child. Result: Primiparity is still one of the main drivers of episiotomy with a significant increase of the use of episiotomy for women who are between 25 and 29 years old. Moreover, the risk of episiotomy is multiplied by 8.79 in case of past unique c-section (OR=8.79 [1.99, 38.91]). Intact perineum history (OR=0.0513 CI [0.0028, 0.9312]), maternal expulsive efforts with lower-part presentations (OR=0.54 [0.29, 1]), and short duration of maternal expulsive efforts (less than 25 minutes) are factors limiting the risk of episiotomy (OR=0.56 [0.33, 0.96]), whereas duration of maternal expulsive efforts lasting between 25 and 35 minutes increases the risk (OR=2.04, CI [1.12, 3 71]). Conclusion: Even if systematic episiotomy is no longer part of morals, some indications seem to persist and to influence midwives' practice. It is necessary to develop a more regular and multicenter assessment of midwives' practices in order to allow women to have a better approach of this clinical practice. It is also important to provide women objective and impartial information meeting their expectations.
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Submitted on : Friday, August 22, 2014 - 5:10:46 PM
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  • HAL Id : dumas-01057498, version 1


Julie Iaconelli. Le recours à l'épisiotomie : déterminants de la pratique des sages-femmes. Étude à la maternité de Port-Royal. Gynécologie et obstétrique. 2014. ⟨dumas-01057498⟩



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