birth, non complicated
Lancet. 1993 Dec 18-25;342(8886-8887):1517-8 Randomized Controlled Trial
IN birth, non complicated The Use of
routine episiotomy
As Treatment, Acute
Is worse Than
selective episiotomy (limited to specified maternal or fetal indications)
To reduce perineal trauma: severe perineal trauma was uncommon in both groups (1.2% routinary VS 1.5% selective) and perineal pain, healing complications, and dehiscence were all more frequent with routinary episiotomy.
CMAJ. 1995 Sep 15;153(6):769-79 Randomized Controlled Trial
IN birth, non complicated, evidence based medicine, bias, physician beliefs influence in patient outcomes The Use of
physicians with favourably views of episiotomy
As Treatment, Acute
Is worse Than
physicians who viewed episiotomy very unfavorably
To reduce perineal trauma (intact perineum 12% in intv. VS 23% in ctrl.) and provide their patients satisfaction with the birth experience. The first stage of labour was 2.3 to 3.5 hours shorter and they used more frequently techniques to expedite labour.
N Engl J Med. 2008 May 1;358(18):1929-40 Randomized Controlled Trial, Multicenter Study
IN evidence based medicine, implementation, knowledge transfer, birth, non complicated The Use of
multifaceted educational intervention combining: opinion leaders, interactive workshops, training of manual skills, detailing visits with attendants, reminders, and feedback
As Treatment, Chronic
Is better Than
no intervantion
To change practice in real setting: use of prophylactic oxytocin increased from 2.1% at baseline to 83.6%, reducing the rate of postpartum hemorrhage, and use of episiotomy decreased from 41.1% to 29.9%.