Conceptos Categóricos

DESTACAN LA IMPORTANCIA DEL ANGULO DE LA EPISIOTOMIA

DESTACAN LA IMPORTANCIA DEL ANGULO DE LA EPISIOTOMIA

(especial para SIIC © Derechos reservados)
Actualmente se recomienda que el ángulo de incisión de la episiotomía mediolateral sea de al menos 60° y en dirección de la tuberosidad isquial.
Autor:
Vladimir Kalis
Columnista Experto de SIIC

Institución:
Charles University


Artículos publicados por Vladimir Kalis
Coautores
Robert Zemcik* Zdenek Rusavy** Jaroslava Karbanova** Magdalena Jansova* Milena Kralickova** Zdenek Novotny** 
University of West Bohemia, Pilsen, República Checa*
Charles University, Praga, República Checa**
Recepción del artículo
31 de Diciembre, 2010
Aprobación
12 de Julio, 2011
Primera edición
11 de Octubre, 2011
Segunda edición, ampliada y corregida
19 de Julio, 2012

Resumen
La metodología de los estudios que evalúan el papel de la episiotomía mediolateral carecen de la calidad necesaria y no puede extraerse actualmente de ellos conclusión alguna acerca del traumatismo perineal grave y la incontinencia anal. Se identificaron cuatro problemas: la definición y la ejecución práctica de la episiotomía mediolateral, y el diagnóstico y clasificación del traumatismo perineal. La definición y ejecución de la episiotomía mediolateral difieren ampliamente entre las distintas instituciones y los distintos individuos. El problema principal es la precisión de la dirección elegida. Se introdujeron tres términos: ángulo de incisión, de sutura y de cicatrización de episiotomía. Anteriormente, la episiotomía mediolateral se definía por un ángulo de incisión mínimo de 40°. Sin embargo, cuando se incide a 40°, el ángulo mediano luego de la reparación era de 20°, mientras que el ángulo de cicatrización era de 30° en los casos de desgarros de tercer grado frente a 38° en los controles. Al usar un ángulo de incisión de 60°, el ángulo mediano de sutura fue de 45° y el de cicatrización de 48°. Actualmente se propone que la episiotomía mediolateral se defina como "una incisión en el perineo durante la última parte de la segunda etapa del trabajo de parto, que comienza en el perineo medial pero se dirige lateralmente en un ángulo de al menos 60° en dirección de la tuberosidad isquial". Se requieren más investigaciones para evaluar la seguridad de este ángulo de incisión.

Palabras clave
definición, episiotomía mediolateral, ángulo de episiotomía, traumatismo perineal, incontinencia anal


Artículo completo

(castellano)
Extensión:  +/-9.66 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

Abstract
Methodology in studies assessing the role of mediolateral episiotomy lacks currently required quality and no clear conclusion can be drawn at present concerning severe perineal trauma and anal incontinence. Four problems were identified: definition and practical execution of mediolateral episiotomy, and diagnostics and classification of perineal trauma.
The definition and execution of mediolateral episiotomy differ widely between institutions and individuals. The main problem is precision of the intended direction.
Three terms were introduced: incision, suture and scar angles of episiotomy. Formerly, the lower limit of 40° was calculated for the definition of mediolateral episiotomy. However, when cut at 40°, the median angle after repair was 20° while the mean scar angle measured 30° in cases with third degree tear compared to 38° in controls.
When an incision angle of 60° was used, the median suture angle was 45° and the scar angle 48°. It is now proposed to define mediolateral episiotomy as "an incision of the perineum during the last part of the second stage of labor beginning in the perineal midline but directed laterally at an angle of at least 60° in the direction of ischial tuberosity." Further research is needed to evaluate the safety of this incision angle.



Motto: "There is no indication that the debates concerning episiotomy will be resolved soon. However, we can hope that better designed scientific studies will be conducted to target the important issues and provide one answer at a time. This will help guide our direction instead of moving in circles and repeating the errors of the past." (Delancey JO).1

Key words
definition, mediolateral episiotomy, angle of episiotomy, perineal trauma, anal incontinence


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: Anestesiología, Cirugía, Enfermería, Medicina Familiar



Comprar este artículo
Extensión: 9.66 páginas impresas en papel A4

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



Enviar correspondencia a:
Vladimir Kalis, Charles University Faculty of Medicine University Hospital Department of Obstetrics and Gynecology, 304 60, Alej Svobody 80, Praga, República Checa
Bibliografía del artículo
1.Delancey JO. Episiotomy: What's the angle? Int J Gynecol Obstet 103(1):3-4, 2008.
2.Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev 21;(1):CD000081, 2009.
3.Thacker SB, Banta DH. Benefits and risks of episiotomy: an interpretative review of the English language literature, 1860-1980. Obstet Gynecol Surv 38(6):322-38, 1983.
4.Karbanova J, Stepan J Jr, Kalis V, et al. Mediolateral episiotomy and anal sphincter trauma. Ceska Gynekol 74(4):247-51, 2009.
5.Argentine Episiotomy Trial Collaborative Group. Routine vs. selective episiotomy: a randomized trial. Lancet 342:1517-8, 1993.
6.Dannecker C, Hillemanns P, Strauss A, Hasbargen U, Hepp H, Anthuber C. Episiotomy and perineal tears presumed to be imminent: randomized controlled trial. Acta Obstet Gynecol Scand 83(4):364-8, 2004.
7.Eltorkey MM, Al Nuaim MA, Kurdi AM, Sabagh TO, Clarke F. Episiotomy, elective or selective: a report of a random allocation trial. Journal of Obstetrics and Gynaecology 14:317-20, 1994.
8.Harrison RF, Brennan M, North PM, Reed JV, Wickham EA. Is routine episiotomy necessary? BMJ 288:1971-5, 1984.
9.House MJ, Cario G, Jones MH. Episiotomy and the perineum: a random controlled trial. Journal of Obstetrics and Gynaecology 7:107-10, 1986.
10.Klein MC, Gauthier RJ, Jorgensen SH, Robbins JM, Kaczorowski J, Johnson B, et al.Does episiotomy prevent perineal trauma and pelvic. Current Clinical Trials 1992; Vol. Doc No 10:[6019 words; 65 paragraphs].
11.Sleep J, Grant AM, Garcia J, Elbourne DR, Spencer JAD, Chalmers I. West Berkshire perineal management trial. BMJ 289:587-90, 1984.
12.Rodriguez A, Arenas EA, Osorio AL, Mendez O, Zuleta JJ. Selective vs routine midline episiotomy for the prevention of third- or fourthdegree lacerations in nulliparous women. Am J Obstet Gynecol 198(3):285.e1-285.e4, 2008.
13.Coats PM, Chan KK, Wilkins M, Beard RJ. A comparison between midline and mediolateral episiotomies. Br J Obstet Gynaecol 87:408-12, 1980.
14.Detlefsen GU, Vinther S, Larsen P, Schroeder E. Median and mediolateral episiotomy [Median og mediolateral episiotomi]. Ugeskrift for Laeger 142(47):3114-6, 1980.
15.Werner Ch, Schuler W, Meskendahl I. Midline episiotomy versus medio-lateral episiotomy - a randomized prospective study. Proceedings of 13thWorld Congress of Gynaecology and Obstetrics (FIGO) (Book 1); 1991 Sept 15-20; Singapore. 1991:33.
16.Woodman PJ, Graney DO. Anatomy and physiology of the female perineal body with relevance to obstetrical injury and repair. Clin Anat 15(5):321-34, 2002.
17.Fernando RJ, Sultan AH, Radley S, Jones PW, Johanson RB. Management of obstetric anal sphincter injury: a systematic review & national practice survey. BMC Health Serv Res 2(1):9, 2002.
18.Sultan AH, Kamm MA, Hudson CN. Obstetric perineal trauma: an audit of training. J Obstet Gynecol 15:19-23, 1995.
19.Groom KM, Paterson-Brown S. Can we improve on the diagnosis of third degree tears? European J Obstet Gynecol Reprod Biol 101(1):19-21, 2002.
20.Kalis V, Chaloupka P, Turek J, Rokyta Z. [Risk Factors of the Third and Fourth Degree Perineal Tear] Ceska Gynekol 70(1):30-6, 2005.
21.Andrews V, Sultan AH, Thakar R, Jones PW. Occult anal sphincter injuries--myth or reality? BJOG 113(2):195-200, 206.
22.RCOG Guideline No 29. Management of third and fourth degree perineal tears following vaginal delivery. March 2007.
23.Signorello LB. Midline episiotomy and anal incontinence: retrospective cohort study. BMJ 320:86-90, 2000
24.Shiono P, Klebanoff MA, Carey JC. Midline episiotomies: more harm than good? Obstet Gynecol 75:765-70, 1990
25.Green JR, Soohoo SL. Factors associated with rectal injury in spontaneous deliveries. Obstet Gynecol 73:732-8, 1989.
26.Gass MS, Dunn C, Stys SJ. Effect of episiotomy on the frequency of vaginal outlet laceracions. J Reprod Med 31:240-4, 1986
27.Bodner-Adler B, Bodner K, Kaider A, et al. Risk factors for third-degree perineal tears in vaginal deliveries with an analysis of episiotomy types. J Reprod Med 46:752-756, 2001
28.Le Ray C, Audibert F, Cabrol D, Goffinet F. [Conséquences périnéales selon les pratiques obstétricales : une étude comparative " ici-ailleurs " Canada-France]. [In Process Citation] J Obstet Gynaecol Can 31(11):1035-44, 2009.
29.Lappen JR, Gossett DR. Episiotomy Practice: Changes and Evidence-based Medicine in Action: Areas of Uncertainty. Expert Rev of Obstet Gynecol 5(3):301-309, 2010.
30.Kalis V, Stepan J Jr., Horak M, Roztocil A, Kralickova M, Rokyta Z. Definitions of mediolateral episiotomy in Europe. Int J Gynecol Obstet 100(2):188-9, 2008.
31.Andrews V, Thakar R, Sultan AH, Jones PW. Are mediolateral episiotomies actually mediolateral? BJOG 112(8):1156-8, 2005.
32.Tincello DG, Williams A, Fowler GE, Adams EJ, Richmond DH, Alfirevic Z. Differences in episiotomy technique between midwives and doctors. BJOG 110(12):1041-4, 2003.
33.Kalis V, Karbanova J, Horak M, Lobovsky L, Kralickova M, Rokyta Z. The incision angle of mediolateral episiotomy before delivery and after repair. Int J Gynecol Obstet 103(1):5-8, 2008.
34.van Dillen J, Spaans M, van Keijsteren W, van Dillen M, Vredevoogd C, van Huizen M, Middeldorp A. A prospective multicenter audit of labor-room episiotomy and anal sphincter injury assessment in the Netherlands. Int J Gynecol Obstet 108(2):97-100, 2010.
35.Kalis V, Ladsmanova J, Bednarova B, Karbanova J, Laine K, Rokyta Z. Evaluation of the incision angle of mediolateral episiotomy at 60 degrees - a pilot study. Accepted by Int J Gynecol Obstet, 2010.
36.Cunningham FG, McDonald PC, Gant NF, Leveno KJ, Gilstrap LC III. Williams Obstetrics. 21st edition, McGraw-Hill Companies, Inc; 2001.
37.Baker PN, Monga A. Obstetric procedures. In: Obstetrics by Ten Teachers. London: Arnold: 285-303, 1995.
38.ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. Obstet Gynecol 107(4):957-62, 2006.
39.Dudenhausen JW, Pschyrembel W. Praktische Geburtshilfe mit geburtshilflichen Operationen [Practical Obstetrics and Obstetrical Operations]. 19th ed. Berlin: de Gruyter. p. 290-1; 2001.
40.Cech E, Hajek Z, Marsal K, Srp B et al. Porodnictví. [Obstetrics]. 2nd ed. Grada Publishing; 2006.
41.Martius H, Martius G. Geburtshilfliche Operationen. Stuttgart: Georg Thieme Verlag:154-155, 1967.
42.Beischer NA, MacKay EV, Colditz P. Obstetrics and the Newborn. London: W.B. Saunders Company Ltd. p. 459-66; 1997.
43.Grigoriadis T, Athanasiou S, Zisou A, Antsaklis A. Episiotomy and perineal repair practices among obstetricians in Greece. Int J Gynecol Obstet 106(1):27-9, 2009.
44.Karbanova J, Landsmanova J, Novotny Z. The angle of mediolateral episiotomy using ischial tuberosity as a reference point. 107(2):157, 2009.
45.McDonald S. The transition and the second stage of labour. In: Myles' Textbook for Midwives. 15th Edition. Churchill Livingstone, London, 2009: 509-31.
46.O'Brien WF, Cefalo RC. Labour and delivery. In: Gabbe SG, Niebyl NJ (eds) Obstetrics: Normal and Problem Pregnancies. New York: Churchill Livingstone.pp. 427-455; 1991.
47.Eogan M, Daly L, O'Connell P, O'Herlihy C. Does the angle of episiotomy affect the incidence of anal sphincter injury? BJOG 113(2):190-4, 2006.
48.Kalis V, Chaloupka P, Turek J, Sucha R, Rokyta Z. [Vaginal delivery in primiparas and anal incontinence]. Ceska Gynekol 68(5):312-20, 2003.
49.van Brummen HJ, Bruinse HW, van de Pol G, Heintz AP, van der Vaart CH. Defecatory symptoms during and after the first pregnancy: prevalences and associated factors. Int Urogynecol J Pelvic Floor Dysfunct 17(3):224-30, 2006.
50.Zetterström JP, López A, Anzén B, Dolk A, Norman M, Mellgren A. Anal incontinence after vaginal delivery: a prospective study in primiparous women. Br J Obstet Gynaecol 106(4):324-30, 1999.
51.Buhling KJ, Schmidt S, Robinson JN, Klapp C, Siebert G, Dudenhausen JW. Rate of dyspareunia after delivery in primiparae according to mode of delivery. Eur J Obstet Gynecol Reprod Biol 124(1):42-6, 2006.
52.Signorello LB, Harlow BL, Chekos AK, Repke JT. Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. Am J Obstet Gynecol 184(5):881-8, 2001.
53.Kalis V, Karbanova J, Bukacova Z, Bednarova B, Rokyta Z, Kralickova M. Anal dilation during labor. Int J Gynaecol Obstet 109(2):136-9, 2010.

 
 
 
 
 
 
 
 
 
 
 
 
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