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OB: Ritgen's AvoidanceFrom: art fougner, md (evsono@pipeline.com)Mon Jul 29 08:24:16 2002
This in today's ReutersHealth - pity Woolley isn't around to comment. Avoiding manual pressure on perineum reduces risk of episiotomy after childbirth Last Updated: 2002-07-26 9:35:48 -0400 (Reuters Health) NEW YORK (Reuters Health) - An innovative "hands-poised" method of childbirth during vaginal delivery reduces the risk of perineal trauma and the need for episiotomy compared with the traditional "hands-on" approach, Austrian investigators report. More than 1000 women with an uncomplicated pregnancy in cephalic presentation were randomly assigned to one of the two delivery methods. Dr. Klaus Mayerhofer, of the University of Vienna Medical School, and associates discuss their findings in The Journal of Reproductive Medicine for June. In the Ritgen hands-on method, first reported in 1828, "the left hand of the midwife puts pressure on the infant's head, and the right hand is placed against the perineum." This is done as a means of supporting the perineum and to provide lateral flexion to ease delivery of the infant's shoulders. The new method, described in 1998, involves the clinician keeping his or her hands poised to apply light pressure to the infant's head if necessary, but the perineum is not touched. In their prospective study, Dr. Mayerhofer observed a similar incidence of perineal tears in the two groups. However, the hands-on method resulted in third-degree perineal tears in 2.7% of patients, versus 0.9% of those receiving hands-poised care (p=0.035). Episiotomy was required in 17.9% and 10.1% of patients, respectively (p=0.001). The researchers suggest that tension during delivery causes the perineum to become thinner and more vulnerable. "Additional pressure applied by the midwife may result in ischemia in the perineal tissue and facilitate severe perineal injury," they surmise. The Austrian team concludes that the hands-poised method is a safe and effective birthing alternative. J Reprod Med 2002;47:477-482. art
-- art fougner, md ich bin ein New Yorker
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