Continues to discourage routine episiotomy. as part of the July issue of Obstetrics and Gynecology, according to an ACOG press release. A new ACOG clinical management guideline has recommended that the procedure be restricted, although it did not issue any specifics about. Episiotomy is performed to enlarge the birth outlet and facilitate delivery of the fetus. Routine use of episiotomy ACOG Practice Bulletin No.
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ACOG: New Guidance to Prevent Vaginal Tearing During Delivery | Medpage Today
Friday, June 24, ACOG updates recommendations for preventing obstetric lacerations during vaginal delivery. This was developed to be much more comprehensive and to reaffirm to physicians that episiotomy is not recommended as routine part of delivery. The acpg advises obstetrics practitioner against the routine use of episiotomy to decrease perineal lacerations, instead take other measures to mitigate the risk.
A review involving 8 trials and 11, randomized women have concluded that warm compress on the perineum during pushing is associated with decreased incidence of perineal trauma. Perineal massage, either during first stage or during the second stage of labor, can decrease muscular resistance and reduce the likelihood of laceration.
Many other trials have confirmed the benefit of perineal massage but ACOG did not recommend perineal support due to lack of sufficient information and clinical methods. Based on clinical data ACOG recommends restrictive use of episiotomy as compared to routine use. A systemic review  found many benefits of restrictive use over routine use like acoog perineal trauma, less suturing and fewer healing complications.
The bulletin quotes “Current data acogg clinical opinion suggest that there are insufficient objective evidence-based criteria to recommend episiotomy, especially routine use of episiotomy, and that clinical judgment remains the best guide for use of this procedure.
National Episiotomy rates have steadily decreased sincewhen ACOG guidelines did not recommend routine episiotomy.
Data on timing of giving episiotomy was sparse as also its benefit or harm in cases acg shoulder dystocia or operative vaginal delivery. Clear consensus also could not be reached on any single birthing position and delayed pushing after full dilatation leading to decreased perineal lacerations and episiotomy. Minor tears of anterior vaginal wall and labia can be left to heal by itself after achieving hemostasis while periurethral, periclitoral and large labial laceration with bleeding should be repaired.
Episiitomy are advised to use clinical judgement when it comes to repair first- or second-degree lacerations due to lack of evidence. The choice of suture material should be continuous absorbable synthetic ones, such as polyglactin.
Full episiogomy external anal sphincter repair should be done end-to-end or overlap with a single dose of antibiotics at the time of repair. Cesarean delivery may be offered to women who with history of OASIS if she experienced anal incontinence, wound infections, repeat surgery or psychological trauma.
It also does not recommend the routine use of endoanal ultrasonography immediately after labor to detect occult OASIS, but advocates that a trained clinical research fellow should examine the patient before the suturing perineal tear by the attending physician.
The bulletin also provided recommendations for long term monitoring and pelvic floor exercises. Posted by anjali vyas at 6: Newer Post Older Post Home.