• 作者：L. Aceituno ; ^{laceitunov@sego.es} ; M.H. Segura ; E. Ruiz ; M.T. Sá ; nchez-Barroso ; V. Acosta ; L. Delgado ; A.I. Barqueros
• 关键词：Desgarros de III y IV grados ; Episiotomí ; a ; Analgesia epidural ; Parto instrumental
• 刊名：Cl铆nica e Investigaci贸n en Ginecolog铆a y Obstetricia
• 出版年：2011
• 期刊代码：pca89_0210573X
• 类别：med
• 出版时间：January-February 2011
• 卷：38
• 期：1
• 页码：8-14
• 文件大小：152 K

Background

Severe (third- or fourth-grade) perineal tears during delivery lies in their ability can produce fecal incontinence. We decided to establish a strategy to reduce the incidence of severe tears during delivery.

Material and methods

The strategy was as follows: 1) pain relief options other than epidural were offered; 2) active pushing was delayed until there was maternal urge; 3) upright positions for pushing and delivery were offered; 4) the indication for instrumental delivery was based on the American College of Obstetricians and Gynecologists鈥?definitions for instrumental delivery, 5) ventouse extraction was used as the instrument of choice, and 6) the use of episiotomy was restricted.

Results

The rate of severe tears significantly decreased (1.56% 鈥?#xA0;0.84%).

Conclusions

A strategy agreed between midwives and gynecologists can significantly reduce the incidence of severe perineal tears. This reduction was achieved without changing the rate of cesarean sections.