Expertos Invitados





LA EPISIOTOMIA COMBINADA CON PARTO QUIRURGICO VAGINAL AUMENTARIA EL RIESGO DE RUPTURA DEL ESFINTER

(especial para SIIC © Derechos reservados)
Algunos estudios observacionales sugieren que la episiotomía mediolateral debe ser el método preferido para reducir la incidencia de traumatismo perineal grave cuando se utilizan instrumentos -especialmente fórceps- en los partos quirúrgicos vaginales. Las episotomías de la línea media deben evitarse combinadas con partos quirúrgicos vaginales ya que parecen aumentar sustancialmente el riesgo de ruptura del esfínter.
Autor:
h Mastoroudes
Columnista Experto de SIIC

Institución:
Worthing Hospital

Artículos publicados por h Mastoroudes
Coautores
M. Gorti* G. Hudelist** 
Worthing Hospital, Worthing, Reino Unido*
Villach Medical Center, Villach, Austria**
Recepción del artículo
16 de Abril, 2007 		Aprobación
31 de Julio, 2007
Primera edición
8 de Octubre, 2008 		Segunda edición, ampliada y corregida
7 de Junio, 2021

LA EPISIOTOMIA COMBINADA CON PARTO QUIRURGICO VAGINAL AUMENTARIA EL RIESGO DE RUPTURA DEL ESFINTER

Resumen
Los desgarros perineales de tercer grado son una complicación importante en el parto por vía vaginal y son más frecuentes en los partos quirúrgicos vaginales. Varios estudios han comunicado sobre los factores de riesgo relacionados con traumatismo perineal grave y sus complicaciones como incontinencia fecal y urinaria. Dentro de esto, sigue siendo controvertido el papel, la realización y el tipo de episiotomía, especialmente cuando se combinan con partos quirúrgicos vaginales. Si bien las episiotomías de la línea media y laterales se realizan habitualmente combinadas con partos quirúrgicos vaginales, su papel en la prevención de traumatismo perineal grave en estos partos sigue siendo poco claro. Para dilucidar el impacto de la episiotomía de la línea media y mediolateral juntamente con los partos quirúrgicos vaginales, esta revisión se concentra en los riesgos y beneficios potenciales de estos tipos de episiotomía y su papel en estos partos.

Palabras clave
episiotomía, lesión perineal, incontinencia fecal, incontinencia urinaria, trauma perineal


Artículo completo
(castellano)
Extensión:  +/-7.17 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

The role of episiotomy in instrumental delivery-is it preventative for severe perineal injury?

Abstract
Third degree perineal tears are a major complication in vaginal childbirth and are more frequent in vaginal operative deliveries (VOD). Several studies have reported on risk factors associated with severe perineal trauma and its complications such as fecal and urinary incontinence. Within this, the role performance and type of episiotomy remains controversial, especially if combined with VOD. Although midline and mediolateral episiotomies are commonly performed in combination with VOD, their role for prevention of severe perineal trauma in VOD is still unclear. In order to elucidate the impact of midline and mediolateral episiotomy in conjunction with VOD, the present review focuses on the potential risks and benefits of these episiotomy types and their role in VOD.

Key words
episiotomy, perineal injury, fecal incontinence, urinary incontinence, perineal trauma


Full text
(english)
 para suscriptores/ assinantes
Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Obstetricia y Ginecología
Relacionadas: Cirugía



Comprar este artículo
Extensión: 7.17 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra



Enviar correspondencia a:
Gernot Hudelist, Worthing Hospital Department of Obstetrics and Gynaecology, BN11 2DH, Lyndhurst Road, Worthing, Reino Unido
Bibliografía del artículo
1. Barter RH, Parks J, Tyndal C. Median episiotomies and complete perineal lacerations. Am J Obstet Gynecol 80:654-662, 1960.
2. De Leeuw JW, Vierhout ME, Struijk PC, Hop WC, Wallenburg HC. Anal sphincter damage after vaginal delivery: functional outcome and risk factors for fecal incontinence. Acta Obstet Gynecol Scand 80:830-834, 2001.
3. Sieber EH, Kroon JD. Morbidity in the third-degree laceration. Obstet Gynecol 19:677-680, 1962.
4. Carley ME, Carley JM, Vasdev G, et al. Factors that are associated with clinically overt postpartum urinary retention after vaginal delivery. Am J Obstet Gynecol 187:430-433, 2002.
5. Combs CA, Robertson PA, Laros RK, Jr. Risk factors for third-degree and fourth-degree perineal lacerations in forceps and vacuum deliveries. Am J Obstet Gynecol 163:100-104, 1990.
6. Angioli R, Gomez-Marin O, Cantuaria G, O'Sullivan M J. Severe perineal lacerations during vaginal delivery: the University of Miami experience. Am J Obstet Gynecol 182:1083-1085, 2000.
7. Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 189:1543-1549; discussion 1549-1550, 2003.
8. Sultan AH, Kamm MA, Hudson CN, Bartram CI. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 308:887-891, 1994.
9. Signorello LB, Harlow BL, Chekos AK, Repke JT. Midline episiotomy and anal incontinence: retrospective cohort study. BMJ 320:86-90, 2000.
10. Chaliha C, Sultan AH, Bland JM, Monga AK, Stanton SL. Anal function: effect of pregnancy and delivery. Am J Obstet Gynecol 185:427-432, 2001.
11. Haadem K, Dahlstrom JA, Lingman G. Anal sphincter function after delivery: a prospective study in women with sphincter rupture and controls. Eur J Obstet Gynecol Reprod Biol 35:7-13, 1990.
12. Nygaard IE, Rao SS, Dawson JD. Anal incontinence after anal sphincter disruption: a 30-year retrospective cohort study. Obstet Gynecol 89:896-901, 1997.
13. Aukee P, Sundstrom H, Kairaluoma MV. The role of mediolateral episiotomy during labour: analysis of risk factors for obstetric anal sphincter tears. Acta Obstet Gynecol Scand 85:856-860, 2006.
14. Andrews V, Sultan AH, Thakar R, Jones PW. Risk factors for obstetric anal sphincter injury: a prospective study. Birth 33:117-122, 2006.
15. Sheiner E, Levy A, Walfisch A, Hallak M, Mazor M. Third degree perineal tears in a university medical center where midline episiotomies are not performed. Arch Gynecol Obstet 271:307-310, 2005.
16. Voyvodic F RN, Skinner S, Schloithe AC, Saccone GT, Sage MR, Wattchow DA. Endosonographic imaging of anal sphincter injury: does the size of the tear correlate with the degree of dysfunction? Dis Colon Rectum 46:735-741, 2003.
17. Starck M BM, Valentin L. Results of endosonographic imaging of theanal sphincter 2-7 days after primary repair of third- or fourth-degree obstetric sphincter tears. Ultrasound Obstet Gynecol 22:609-615, 2003.
18. Faltin DL BM, Floris LA, Irion O. Diagnosis of anal sphincter tears to prevent fecal incontinence: a randomized controlled trial. Obstet Gynecol 106:6-13, 2005.
19. Bek KM, Laurberg S. Risks of anal incontinence from subsequent vaginal delivery after a complete obstetric anal sphincter tear. Br J Obstet Gynaecol 99:724-726, 1992.
20. Bodner K, Bodner-Adler B, Wagenbichler P, et al. Perineal lacerations during spontaneous vaginal delivery. Wien Klin Wochenschr 113:743-746, 2001.
21. Bodner-Adler B, Bodner K, Kaider A, et al. Risk factors for third-degree perineal tears in vaginal delivery, with an analysis of episiotomy types. J Reprod Med 46:752-756, 2001.
22. Poen AC, Felt-Bersma RJ, Dekker GA, Deville W, Cuesta MA, Meuwissen SG. Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy. Br J Obstet Gynaecol 104:563-566, 1997.
23. Shiono P, Klebanoff MA, Carey JC. Midline episiotomies: more harm than good? Obstet Gynecol 75:765-770, 1990.
24. Henriksen TB, Bek KM, Hedegaard M, Secher NJ. Episiotomy and perineal lesions in spontaneous vaginal deliveries. Br J Obstet Gynaecol 99:950-954, 1992.
25. Buekens P, Lagasse R, Dramaix M, Wollast E. Episiotomy and third-degree tears. Br J Obstet Gynaecol 92:820-823, 1985.
26. Hudelist G, Gelle'n J, Singer C, et al. Factors predicting severe perineal trauma during childbirth: role of forceps delivery routinely combined with mediolateral episiotomy. Am J Obstet Gynecol 192:875-881, 2005.
27. Baumann P, Hammoud AO, McNeeley SG, Derose E, Kudish B, Hendrix S. Factors associated with anal sphincter laceration in 40,923 primiparous women. Int Urogynecol J Pelvic Floor Dysfunct 2007.
28. Benifla JL, Abramowitz L, Sobhani I, et al. Postpartum sphincter rupture and anal incontinence: prospective study with 259 patients. Gynecol Obstet Fertil 28:15-22, 2000.
29. Jander C, Lyrenas S. Third and fourth degree perineal tears. Predictor factors in a referral hospital. Acta Obstet Gynecol Scand 80:229-234, 2001.
30. Klein MC, Gauthier RJ, Robbins JM, et al. Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol 171:591-598, 1994.
31. Kudish B, Blackwell S, McNeeley SG, et al. Operative vaginal delivery and midline episiotomy: a bad combination for the perineum. Am J Obstet Gynecol 195:749-754, 2006.
32. Ecker JL, Tan WM, Bansal RK, Bishop JT, Kilpatrick SJ. Is there a benefit to episiotomy at operative vaginal delivery? Observations over ten years in a stable population. Am J Obstet Gynecol 176:411-414, 1997.
33. Nakai A, Yoshida A, Yamaguchi S, et al. Incidence and risk factors for severe perineal laceration after vaginal delivery in Japanese patients. Arch Gynecol Obstet 274:222-226, 2006.
34. Eogan MDL, O'Connell PR, O'Herlihy C. Does the angle of episiotomy affect the incidence of anal sphincter injury? Br J Obstet Gynaecol 556:190-194, 2006.
35. Gupta N, Kiran TU, Mulik V, Bethel J, Bhal K. The incidence, risk factors and obstetric outcome in primigravid women sustaining anal sphincter tears. Acta Obstet Gynecol Scand 82:736-743, 2003.
 
 
 
 
 
 
Clasificado en
Artículos originales>
Expertos del Mundo

Especialidad principal:
Obstetricia y Ginecología


Relacionadas:
Cirugía
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618
Inicio/Home

Copyright siicsalud © 1997-2024 ISSN siicsalud: 1667-9008