WHAT DOES THE OBSTETRICIAN KNOWABOUT EPISIOTOMY?
E. CORTES1, J.BARBABOSA 2, A. SANCHEZ 1, M. MORALES GOMEZ 3,E. C. BALTAZAR 4, N. L. VILLANUEVA 5;
1Urogynecology and Reconstructive Pelvic Surgery, CMN"20 DE NOVIEMBRE" ISSSTE, Mexico City, Mexico, 2Obstetricsand Gynecology Department, HOSGENAES Secretaría de Marina, MexicoCity, Mexico, 3The Spanish Hosp., Mexico City, Mexico,4Obstetrics and Gynecology, Hosp. Gen. Dr. Enrique CabreraCossio de la, Atizapan de Zaragoza. Estado de Mexico, Mexico, 5Hosp.Gen. Dr. Enrique Cabrera, Coacalco de Berriozabal, Mexico.
Introduction: Episiotomy is oneof the most frequently performed obstetric surgical procedures. It isnow known that to reduce the risk of Obstetric Anal SphincterInjuries (OASIS), the type of episiotomy, the cutting angle andrepair technique, as well as the restrictive use of it, are essentialfactors.There is insufficient evidence of how well trained theobstetricians are in this procedure, so a basic knowledge survey willhelp to know the current state and determine trainingstrategies
Objective: To determine how much theobstetrician knows about the aspects of episiotomy related to therisk of OASIS
Methods: An electronic survey was conductedon obstetricians from different public and private institutions inMexico, which consisted of questions about the type of episiotomyperformed, the angle of cut, the type of suture and the suturetechnique employed.
Results: A total of 400 obstetriciansparticipated. 70% of the obstetricians answered that they perform aroutine episiotomy of which 68% is medioateral and 32% midline. Aboutthe cut angle of the episiotomy, 51% answered that they performed itbetween 30 and 40 degrees, 29% between 40 and 60 degrees and 20%between 20-30 degrees.
When investigating the type of suture andthe repair technique, it was found that 67% used catgut and 33%ploglicolic acid, while 65% suture the mucosa with interruptedthecnique and only 35% used a continuous suture.
Conclusions:We found that there is inadequate training of obstetricians whoresponded to the survey on the principles of episiotomy related tothe reduction in risk of OASIS. The morbidity associated withperineal trauma depends on the extent of the trauma, the material andtechnique used for suturing, and the ability of the physician toperform the procedure. It is essential to develop workshops inobstetricians at all levels of training to ensure knowledge in theseprinciples for the reduction of OASIS.
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