PubMed · 13823440
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A R FLEMING. 1960. Complete perineotomy.. https://pubmed.ncbi.nlm.nih.gov/13823440/
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OBJECTIVES: To examine a possible effect on labour of training the muscles of the pelvic floor during pregnancy. DESIGN: Randomised controlled trial. SETTING: Trondheim University Hospital and three outpatient physiotherapy clinics in a primary care setting. PARTICIPANTS: 301 healthy nulliparous women randomly allocated to a training group (148) or a control group (153). INTERVENTION: A structured training programme with exercises for the pelvic floor muscles between the 20th and 36th week of pregnancy. MAIN OUTCOME MEASURES: Duration of the second stage of labour and number of deliveries lasting longer than 60 minutes of active pushing among women with spontaneous start of labour after 37 weeks of pregnancy with a singleton fetus in cephalic position. RESULTS: Women randomised to pelvic floor muscle training had a lower rate of prolonged second stage labour (24%, 95% confidence interval 16% to 33%; 22 out of 105 women were at risk (undelivered) at 60 minutes in the survival analysis) than women allocated to no training (38% (37/109), 28% to 47%). The duration of the second stage was not significantly shorter (40 minutes v 45 minutes, P = 0. 06). CONCLUSIONS: A structured training programme for the pelvic floor muscles is associated with fewer cases of active pushing in the second stage of labour lasting longer than 60 minutes.
Episiotomy is a widely used surgical procedure, introduced in the medical practice with no support of its benefit from scientific evidence. It is still used routinely despite not accomplishing the major goals for which it was pretended. In fact, it does not decrease the risk of severe perineal lacerations, it fails to prevent the development of pelvic relaxation and it does not have any impact in newborn mortality or morbidity. Many trials, retrospective and prospective, have compared general versus selective use of episiotomy. A selective use is associated with better results, such as a decrease of severe lacerations, a highest number of women in whom the perineum remains intact, despite an increase in anterior lacerations. It seems correct to recommend a selective episiotomy, and many authors suggest the use of this procedure in 30% of the cases. It is now very important to improve new birthing techniques that maintain the integrity of the perineum and do not involve surgical procedures. More trials are necessary to clarify which are the real indications to use episiotomy. Meanwhile, without the proper scientific evidence, the most correct attitude seems to be a careful use of episiotomy, with decisions on a case-by-case basis.
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