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Abstract
ABSTRACT
OBJECTIF. Cette étude a été menée dans le but de déterminer les facteurs associés à la déchirure périnéale.
METHODES. Nous avons réalisé une étude cas-témoin sur une durée de 5 mois (1er Décembre 2014 au 30 Avril 2015) dans l’unité de Gynécologie et Obstétrique de l’Hôpital Central de Yaoundé. Nous avons inclus 154 femmes avec déchirure périnéale que nous avons comparées à 154 témoins qui n’avaient pas eu de déchirure périnéale. Les critères d’appariement des 2 groupes étaient l’âge et la parité.
RESULTATS. La moyenne d’âge était de 24,94±4,55 ans (extrêmes: 15 à 39 ans). Les déchirures étaient réparties comme suit: premier degré 148/154 (96%), deuxième degré 5/154 (3%) et troisième degré 1/154 (1%).
Les facteurs de risque indépendants de déchirure étaient: l’antécédent de déchirure périnéale (Rapport de Cotes ajuste (RCa)=14; IC à 95%:[3,3 - 58,7]) , la durée de l’expulsion inférieure a 30 minutes (RCa=2,68 ; IC à 95%:[1,64-4,37];), la stimulation du travail (RCa=1,78; IC à 95% : [1,12-2,83], le périmètre crânien fœtal ≥ 36 centimètres. (RCa=6,8; IC à 95%:[2,7-17,08];).
CONCLUSION. A moins qu’il y ait une contre-indication, les parturientes présentant une des conditions suivantes doivent bénéficier d’une épisiotomie: l’antécédent de déchirure périnéale, la stimulation du travail, la durée du 2ème stade du travail inférieure à 30 min et la macrosomie.
RÉSUMÉ
OBJECTIVE. This study aimed at determining factors associated to perineal tear.
METHODS. We conducted a case-control study over a five months period (December 1, 2014 – April 30, 2015) at the maternity of the Yaounde Central Hospital (Cameroon). One hundred and fifty four women with perineal tear (cases) were compared to 154 women without perineal tear (controls). Cases and controls were paired with respect to age and parity.
RESULTS. The mean age was 24.94±4.55 years (range: 15 to 39 years). Perineal tears were distributed as follows: first degree tear: 148/154 (96%), second degree tear: 5/154 (3%) and third degree tear: 1/154 (1%). Independent risk factors of perineal tears were: past history of perineal tear (ajusted Odds Ratio (aOR)=14; 95%CI:[3.3 – 58.7]), duration of second stage of labor shorter than 30 minutes (aOR=2.68; 95%CI:[1.64 - 4.37]), augmentation of labor (aOR=1.78; 95%C: [1.12-2.83], Head circonference above 36 centimeters. (aOR=6.8; 95%CI:[2.7-17.08]).
CONCLUSION. Parturients with one of the following should undergo episiotomy unless there is a contra-indication: past history of perineal tear, augmentation of labor, second stage of labor shorter than 30 minutes and macrosomia / head circonference above 36 centimeters on third trimester ultrasound.
Article Details
References
- Le Ray C, Audibert F, Cabrol D, Goffinet F. Perineal consequences according to obstetric practices: A comparative study here and elsewhere, Canada and France]. J Obstétrique Gynécologie Can JOGC. 2009 ;31(11):1035–44.
- Landy HJ, Laughon SK, Bailit JL, Kominiarek MA, Gonzalez-Quintero VH, Ramirez M, et al. Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. Obstet Gynecol. 2011;117(3):627–35.
- Batoum V. Mesure de la longueur du périnée obstétrical et prévention des déchirures pendant l’accouchement chez la primipare camerounaise. [Thèse de doctorat en médecine(non publié)]. FMSB; 2005.
- Nkwabong E, Kouam L, Orock GT, Ekono MR, Takang W, Mve KV. Study of Perineal Tears During Delivery of Singletons in Cephalic Presentation. Trop J Obstet Gynaecol. 2013 ;26(2):128–31.
- Traoré B. Les déchirures des parties molles au cours de l’accouchemeent à la maternité du centre de santé de référence de la commune V du district de Bamako [Internet] [Thèse de doctorat en médecine(non publié)]. 2008. Available from: www.keneya.net/fmpos/theses/2008/med/pdf/08M261.
- Dahlen H, Priddis H, Schmied V, Sneddon A, Kettle C, Brown C, et al. Trends and risk factors for severe perineal trauma during childbirth in New South Wales between 2000 and 2008: a population-based data study. BMJ. 2013; 3(5).
- Fritel X. Pelvic floor and pregnancy. Gynécologie Obstétrique Fertil. 2010;38(5):332–46.
- Klein MC, Gauthier RJ, Robbins JM, Kaczorowski J, Jorgensen SH, Franco ED, et al. Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol. 1994;171(3):591–8.
- Bradley MS, Kaminski RJ, Streitman DC, Dunn SL, Krans EE. Effect of rotation on perineal lacerations in forceps-assisted vaginal deliveries. Obstet Gynecol. 2013;122(1):132–7.
- Eason E, Labrecque M, Marcoux S, Mondor M. Anal incontinence after childbirth.Can Med Assoc J J. 2002; 166(3): 326–30.
- Groutz A, Cohen A, Gold R, Hasson J, Wengier A, Lessing JB et al. Risk factors for severe perineal injury during childbirth: a case-control study of 60 consecutive cases. Colorectal Dis Off J Assoc Coloproctology G B Irel. 2011;13(8):e216–9.
- Ojule JD, Oriji VK, Georgewill KN. Perineal trauma in Port Harcourt, Souh-south Nigeria. J Natl Assoc Resid Dr Niger. 2012 ;21(1):36–40.
- Howard D, Davies PS, DeLancey JO, Small Y. Differences in perineal lacerations in black and white primiparas. Obstet Gynecol. 2000; 96(4):622–4.
- Samuelsson E, Ladfors L, Lindblom BG, Hagberg H. A prospective observational study on tears during vaginal delivery: occurrences and risk factors. Acta Obstet Gynecol Scand. 2002;81(1):44–9.
- Smith LA, Price N, Simonite V, Burns EE. Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy Childbirth. 2013;13:59.
- Sheiner E, Walfisch A, Hallak M, Harlev S, Mazor M, Shoham-Vardi I. Length of the second stage of labor as a predictor of perineal outcome after vaginal delivery. J Reprod Med. 2006;51(2):115–9.
- Mikolajczyk RT, Zhang J, Troendle J, Chan L. Risk factors for birth canal lacerations in primiparous women. Am J Perinatol. 2008;25(5):259–64.
- Brohi ZP, Sadaf A, Zohra N, Perveen U. Frequency and severity of perineal tears in Countess Lady Duffrin Fund Hospital, Hyderabad. JPMA J Pak Med Assoc. 2012;62(8):803–6.
References
Le Ray C, Audibert F, Cabrol D, Goffinet F. Perineal consequences according to obstetric practices: A comparative study here and elsewhere, Canada and France]. J Obstétrique Gynécologie Can JOGC. 2009 ;31(11):1035–44.
Landy HJ, Laughon SK, Bailit JL, Kominiarek MA, Gonzalez-Quintero VH, Ramirez M, et al. Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. Obstet Gynecol. 2011;117(3):627–35.
Batoum V. Mesure de la longueur du périnée obstétrical et prévention des déchirures pendant l’accouchement chez la primipare camerounaise. [Thèse de doctorat en médecine(non publié)]. FMSB; 2005.
Nkwabong E, Kouam L, Orock GT, Ekono MR, Takang W, Mve KV. Study of Perineal Tears During Delivery of Singletons in Cephalic Presentation. Trop J Obstet Gynaecol. 2013 ;26(2):128–31.
Traoré B. Les déchirures des parties molles au cours de l’accouchemeent à la maternité du centre de santé de référence de la commune V du district de Bamako [Internet] [Thèse de doctorat en médecine(non publié)]. 2008. Available from: www.keneya.net/fmpos/theses/2008/med/pdf/08M261.
Dahlen H, Priddis H, Schmied V, Sneddon A, Kettle C, Brown C, et al. Trends and risk factors for severe perineal trauma during childbirth in New South Wales between 2000 and 2008: a population-based data study. BMJ. 2013; 3(5).
Fritel X. Pelvic floor and pregnancy. Gynécologie Obstétrique Fertil. 2010;38(5):332–46.
Klein MC, Gauthier RJ, Robbins JM, Kaczorowski J, Jorgensen SH, Franco ED, et al. Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol. 1994;171(3):591–8.
Bradley MS, Kaminski RJ, Streitman DC, Dunn SL, Krans EE. Effect of rotation on perineal lacerations in forceps-assisted vaginal deliveries. Obstet Gynecol. 2013;122(1):132–7.
Eason E, Labrecque M, Marcoux S, Mondor M. Anal incontinence after childbirth.Can Med Assoc J J. 2002; 166(3): 326–30.
Groutz A, Cohen A, Gold R, Hasson J, Wengier A, Lessing JB et al. Risk factors for severe perineal injury during childbirth: a case-control study of 60 consecutive cases. Colorectal Dis Off J Assoc Coloproctology G B Irel. 2011;13(8):e216–9.
Ojule JD, Oriji VK, Georgewill KN. Perineal trauma in Port Harcourt, Souh-south Nigeria. J Natl Assoc Resid Dr Niger. 2012 ;21(1):36–40.
Howard D, Davies PS, DeLancey JO, Small Y. Differences in perineal lacerations in black and white primiparas. Obstet Gynecol. 2000; 96(4):622–4.
Samuelsson E, Ladfors L, Lindblom BG, Hagberg H. A prospective observational study on tears during vaginal delivery: occurrences and risk factors. Acta Obstet Gynecol Scand. 2002;81(1):44–9.
Smith LA, Price N, Simonite V, Burns EE. Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy Childbirth. 2013;13:59.
Sheiner E, Walfisch A, Hallak M, Harlev S, Mazor M, Shoham-Vardi I. Length of the second stage of labor as a predictor of perineal outcome after vaginal delivery. J Reprod Med. 2006;51(2):115–9.
Mikolajczyk RT, Zhang J, Troendle J, Chan L. Risk factors for birth canal lacerations in primiparous women. Am J Perinatol. 2008;25(5):259–64.
Brohi ZP, Sadaf A, Zohra N, Perveen U. Frequency and severity of perineal tears in Countess Lady Duffrin Fund Hospital, Hyderabad. JPMA J Pak Med Assoc. 2012;62(8):803–6.