[Influence of a major decrease in the use of episiotomy applied to a high risk perineal situation: Occiput posterior presentation]

Objectives: Occiput-posterior presentation represents 5% of all deliveries and is a high-risk situation for perineal tears requiring, for some authors, an episiotomy. The aim of this study was to evaluate the impact of an ultra-restrictive policy in the use of episiotomy on perineal tears in this high-risk situation.

Materials and methods: This is a retrospective cohort study in a tertiary maternity comparing perineal outcome of occipito-posterior (OP) to occipito-anterior deliveries. We included all, spontaneous or assisted, live single pregnancies that delivered after 37 weeks in OP from January 2008 to December 2012. This group was then compared to a control group of occipito-anterior pregnancies.

Results: Episiotomy rate was similar in both groups (1.3 versus 1.8 in OP; p=0.5). We found more second degree perineal tears in the OP group (p<0.001) but severe perineal tears rate was similar. There was no increase in post-partum haemorrhage rate. Neonatal outcome was less favourable in the OP group.

Conclusion: A restrictive use of episiotomy in OP does not increase the risk of severe perineal tears and does not worsen perineal prognosis.