Assessment of restrictive episiotomy use and impact on perineal tears in the Burgundy's Perinatal Network

Objectives. To analyse episiotomy and perineal tears rates in Burgundy after French National College of Obstetricians and Gynecologists (CNGOF) guidelines in 2005. Materials and method. Multicenter retrospective study, between 2003-2005 (period 1) et 2012-2014 (period 2), conducted on singletons vaginal deliveries, in cephalic presentation from 37 weeks. We compared the episiotomy rate (ER), and perineal lesions in normal deliveries (ND) and instrumental deliveries (ID) between the two periods. Results. A total of 74,268 women were included, The overall ER significantly decreased from 35.8 to 16.7% (P <0.01), without increasing third degree perineal tears (0.73% vs. 0.66%) or fourth degree (0.14% vs 0.14%). First degree perineal tears rose (42.1% vs 17.6%, P < 0.001), second degree decreased (13.5% vs 20.5%, P <0.001). ER decreased whatever the level of motherhood, healthcare ward, vaginal delivery type, or the instrument used. Conclusion. Our study found a strong impact in Burgundy of the French guidelines for the practice of restrictive episiotomy for both ND and for ID without increasing sphincter tears and in decreasing spontaneous morbidity. (C) 2016 Elsevier Masson SAS. All rights reserved.