Episiotomìa

gr. epìseion, regione pubica-genitale; e tomé, incisione

Incisione chirurgica del perineo che si effettua durante un parto per via naturale, allo scopo di ingrandire l’orifizio vaginale ed impedire così la rottura traumatica del perineo stesso, sebbene non tutti ammettano che la _ sia di protezione. Se indicata, secondo le Linee Guida dell’Associazione Americana Clinici Ostetrici e Ginecologi (ACOG-USA) l’episiotomìa va eseguita quando siano visualizzabili almeno 3-4 cm di testa fetale (in caso di presentazione cefalica) preferibilmente con adeguata anestesia, locale o spinale; è d’obbligo evitare di ledere l’apparato sfinteriale anale e il retto effettuando un’incisione mediolaterale e non mediana, applicando una pressione all’apice perineale in modo che non sia eccessiva l’estensione dell’episiotomìa stessa.

  1. Carroli G, Belizan J. Episiotomy for vaginal birth – Cochrane Review in Cochrane Library 1-2002 Oxford Update Software; 2000; (2):CD000081;
  2. Goldberg J, Purfield P, Roberts N, Lupinacci P, Fagan M, Hyslop T. The Philadelphia Episiotomy Intervention Study. J Reprod Med 2006;51(8):603-9;
  3. Carroli G, Belizan J, Stamp G. Episiotomy policies in vaginal births – Cochrane Review in Cochrane Library, Issue 2. Oxford: Update Software, 1998;
  4. Mahony R, O’Herlihy C. Recent impact of anal sphincter injury on overall Caesarean section incidence. Aust N Z J Obstet Gynaecol 2006;46(3):202-4.
  5. Riethmuller D, Courtois L, Maillet R. Liberal versus restrictive practice of episiotomy: do there exist specific obstetrical indications for episiotomy? J Gynecol Obstet Biol Reprod (Paris) 2006;35(1):1S32-1S39;
  6. de Oliveira SM, Miquilini EC. Frequency and criteria for the indication of episiotomy. Rev Esc Enferm USP 2005;39(3):288-9;
  7. Society of Obstetricians and Gynaecologists of Canada. Guidelines for operative vaginal birth. Number 148, 2004. Int J Gynaecol Obstet 2005;88(2):229-36;
  8. Cargill YM, MacKinnon CJ, Arsenault MY, Bartellas E, Daniels S, Gleason T, Iglesias S, Klein MC, Lane CA, Martel MJ, Sprague AE, Roggensack A, Wilson AK Clinical Practice Obstetrics Committee. Guidelines for operative vaginal birth. J Obstet Gynaecol Can 2004;26(8):747-61;
  9. 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 2004;83(4):364-8;
  10. Allen RE, Hosker GL, Smith ATB, Warrel DW Pelvic floor damage and childbirth: A neurophisiological study. BrJ Obstet Gynaecol 1990; 97; 7709;
  11. Gilpin SA, Gosling JA, Smith ARB, Warrel DW The pathogenesis of genitourinary prolapse and stress incontinence of urine; a histological and histochemical study. Br J Obstet Gynaecol 1989;96:15-23;
  12. Smith ARB, Hosker GL, Warrel DW The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine; a neurophysiological study. Br J Obstet Gynaecol 1989; 96: 24-28;
  13. Handa VL, Harris TA, Ostegard DR. Protecting the pelvic floor: Obstetric management to prevent incontinence and pelvic organ prolapse. Obstet Gynaecol 1996;88(3):470-78;
  14. Foldsprang A, Mommsens S, Larn GW, Elwing L Parity as a correlate adulte female urinary incontinence prevalence. J Epidemiol Commun Health 1992;46:595-600;
  15. Di Stefano M, Caserta D, Marci R, Moscanni M. Urinary incontinence in pregnancy and prevention of perineal complications of labour. Minerva Ginecologica 2000:52:307-311;
  16. Sommer P, Bauer T, Nielsen KK, Kristensen ES, Hermann GG, Steven K. Voiding patterns and prevalence of incontinence in women. A questionnaire survey. Br J Urol 1990; 66(1):12-5;
  17. Thacker SB, Banta HD. Benefits and risks of episiotomy: an interpretative review of the English language literature 1860-1980. Obstet Gynecol Surv 1983; 38: 322-38;
  18. Sultan AH, Karnm MA, Hudson CN, Thomas JM, Bartram C1. Anal sphincter distruption during vaginal delivery. N EnglJ Med 1993; 329:190511;
  19. Zetterstrom JP, Lopez A, Anzen B, Dolk A, Norman M, Mellgren A. Anal incontinence after vaginal delivery: a prospective study in primiparous women. BJOG 1999;106:324-30;
  20. Harrison RF, Brennam M, North PM, Reed JV, Wickman EA. Is routine episiotomy necessary? BMJ 1984; 288:1971-5;
  21. Gordon H, Logue.M. Perineal muscle function after childbirth. Lancet 1985;2:123-5;
  22. Klein MC, Gauthier RJ, Robbins JM, Kaczorowski J, Jorgensen SH, Franco ED et al. Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction and pelvic floor relaxation. Am J Obstet Gynecol 1994; 171: 591-8;
  23. Barisal RK, Tan WM, EckerJL, BishopJT, Upatrick SJ. Is there benefit to episiotomy at spontaneous vaginal delivery? Am J Obstet Gynecol 1996;175:897-901;
  24. The TG. Is routine episiotomy beneficial in low birth weight delivery? IntJ Gynecol Obstet 1990;31:134-40;
  25. WennbergJE, Gittelsohn A. Variations in medical care among small areas. Scientific American 1982;246: 120-34;
  26. Hueston WJ. Factors associated with the use of episiotomy during vaginal delivery. Obstet Gynecol 1996;87: 6:1001-5;
  27. Rockner G, Fianu-Jonasson A. Changed pattern in the use of episiotomy in Sweden. Br J Obstet Gynaecol 1999;106:95-101.
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