Ruptuur en episiotomie

Geschreven door Lisa Heikens en Margot van Dijk
Gepubliceerd op 16 augustus 2022

Tijdens het laatste stuk van de persfase, als het hoofdje van de baby ‘staat’, rekken de vagina, huid en spieren flink op. Toch kan er tijdens de geboorte een scheur(tje) in het perineum, de vaginawand, de bekkenbodemspieren en/of andere weefsels ontstaan. Dit wordt in medische termen een ruptuur genoemd en kan in verschillende gradaties voorkomen. Soms kiest de zorgverlener ervoor om een episiotomie (knip) te (willen) zetten. Bijvoorbeeld bij het gebruik van een vacuümpomp om mogelijk een (sub)totaalruptuur te voorkomen.

Wat is een episiotomie precies en kan dit daadwerkelijk een subtotaalruptuur voorkomen? Wat maakt de kans op een ruptuur kleiner? Wat zijn de effecten van verschillende bevalhoudingen op de kans op een ruptuur? Welke rol heeft de zorgverlener in het voorkomen van een ruptuur? Deze en nog meer vragen zullen in dit artikel worden beantwoord.

Aasheim, V., Nilsen, A. B. V., Reinar, L. M., & Lukasse, M. (2017). Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Systematic Reviews2018(6). https://doi.org/10.1002/14651858.cd006672.pub3

Abdelhakim, A. M., Eldesouky, E., Elmagd, I. A., Mohammed, A., Farag, E. A., Mohammed, A. E., Hamam, K. M., Hussein, A. S., Ali, A. S., Keshta, N. H. A., Hamza, M., Samy, A., & Abdel-Latif, A. A. (2020). Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. International Urogynecology Journal31(9), 1735–1745. https://doi.org/10.1007/s00192-020-04302-8

Ankarcrona, V., Zhao, H., Jacobsson, B., & Brismar Wendel, S. (2021). Obstetric anal sphincter injury after episiotomy in vacuum extraction: an epidemiological study using an emulated randomised trial approach. BJOG: An International Journal of Obstetrics & Gynaecology128(10), 1663–1671. https://doi.org/10.1111/1471-0528.16663

Barjon K, Mahdy H. Episiotomy. [Updated 2022 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546675/

Beckmann, M. M., & Stock, O. M. (2013). Antenatal perineal massage for reducing perineal      trauma. Cochrane Database of Systematic Reviews.             https://doi.org/10.1002/14651858.cd005123.pub3

Begley, C., Guilliland, K., Dixon, L., Reilly, M., Keegan, C., McCann, C., & Smith, V. (2019). A qualitative exploration of techniques used by expert midwives to preserve the perineum intact. Women and Birth32(1), 87–97. https://doi.org/10.1016/j.wombi.2018.04.015

Bohatá, P., & Dostálek, L. (2016). Antepartální možnosti prevence epiziotomie a ruptury           hráze při porodu [The possibility of antepartal prevention of episiotomy and perineal        tears during delivery]. Ceska gynekologie81(3), 192–201.

Buhling, K. J., Schmidt, S., Robinson, J. N., Klapp, C., Siebert, G., & Dudenhausen, J. W. (2006). Rate of dyspareunia after delivery in primiparae according to mode of delivery. European Journal of Obstetrics & Gynecology and Reproductive Biology124(1), 42–46. https://doi.org/10.1016/j.ejogrb.2005.04.008

Crookall, R., Fowler, G., Wood, C., & Slade, P. (2018). A systematic mixed studies review of women’s experiences of perineal trauma sustained during childbirth. Journal of Advanced Nursing74(9), 2038–2052. https://doi.org/10.1111/jan.13724

De Jonge, A., Teunissen, T. A. M., & Lagro-Janssen, A. L. M. (2004). Supine position compared to other positions during the second stage of labor: a meta-analytic review. Journal of Psychosomatic Obstetrics & Gynecology25(1), 35–45. https://doi.org/10.1080/01674820410001737423

De Leeuw, J., De Wit, C., Kuijken, J., & Bruinse, H. (2007). Mediolateral episiotomy reduces the risk for anal sphincter injury during operative vaginal delivery. BJOG: An International Journal of Obstetrics & Gynaecology115(1), 104–108. https://doi.org/10.1111/j.1471-0528.2007.01554.x

Dekker, R. (2022a, januari 5). EBB 206 – Evidence on Perineal Tears and the Importance of Avoiding Episiotomy with EBB Founder, Dr. Rebecca Dekker. Evidence Based Birth®. Geraadpleegd op 21 maart 2022, van https://evidencebasedbirth.com/evidence-on-perineal-tears-and-the-importance-of-avoiding-episiotomy-with-ebb-founder-dr-rebecca-dekker/

Dekker, R. (2022b, maart 15). EBB 216 – The Evidence on Prenatal Perineal Massage for Preventing Tears in Childbirth with Dr. Rebecca Dekker. Evidence Based Birth®. Geraadpleegd op 21 maart 2022, van https://evidencebasedbirth.com/the-evidence-on-prenatal-perineal-massage-for-preventing-tears-in-childbirth-with-dr-rebecca-dekker/

Dekker, R. (2022c, maart 30). EBB 218 – The Evidence on Perineal Massage during Labor with Dr. Rebecca Dekker. Evidence Based Birth®. Geraadpleegd op 1 april 2022, van https://evidencebasedbirth.com/the-evidence-on-perineal-massage-during-labor-with-dr-rebecca-dekker/

de Tayrac, R., Panel, L., Masson, G., & Mares, P. (2006). Episiotomie et prévention des lésions pelvi-périnéales [Episiotomy and prevention of perineal and pelvic floor injuries]. Journal de gynecologie, obstetrique et biologie de la reproduction, 35(1 Suppl), 1S24–1S31.

Doğan, B., Gün, S., Özdamar, Z., Yılmaz, A., & Muhçu, M. (2016). Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain. The Journal of Maternal-Fetal & Neonatal Medicine30(4), 457–460. https://doi.org/10.1080/14767058.2016.1174998

Deliktas, A., & Kukulu, K. (2017). A meta-analysis of the effect on maternal health of upright positions during the second stage of labour, without routine epidural analgesia. Journal of Advanced Nursing74(2), 263–278. https://doi.org/10.1111/jan.13447

Doğan, B., Gün, S., Özdamar, Z., Yılmaz, A., & Muhçu, M. (2016). Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain. The Journal of Maternal-Fetal & Neonatal Medicine30(4), 457–460. https://doi.org/10.1080/14767058.2016.1174998

Elharmeel, S. M., Chaudhary, Y., Tan, S., Scheermeyer, E., Hanafy, A., & Van Driel, M. L. (2011). Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention. Cochrane Database of Systematic Reviewshttps://doi.org/10.1002/14651858.cd008534.pub2

Eogan, M., Daly, L., O’Connell, P., & O’Herlihy, C. (2006). Does the angle of episiotomy affect the incidence of anal sphincter injury?*. BJOG: An International Journal of Obstetrics and Gynaecology113(2), 190–194. https://doi.org/10.1111/j.1471-0528.2005.00835.x

Euro-Peristat. (2010). EUROPEAN PERINATAL HEALTH REPORT: Health and Care of Pregnant Women and Babies in Europe in 2010https://www.europeristat.com/images/doc/EPHR2010_w_disclaimer.pdf

Frenette, P., Crawford, S., Schulz, J., & Ospina, M. B. (2019). Impact of Episiotomy During Operative Vaginal Delivery on Obstetrical Anal Sphincter Injuries. Journal of Obstetrics and Gynaecology Canada41(12), 1734–1741. https://doi.org/10.1016/j.jogc.2019.02.016

Frigerio, M., Mastrolia, S. A., Spelzini, F., Manodoro, S., Yohay, D., & Weintraub, A. Y. (2019).    Long-term effects of episiotomy on urinary incontinence and pelvic organ prolapse: a   systematic reviewArchives of gynecology and obstetrics299(2), 317–325.             https://doi.org/10.1007/s00404-018-5009-9

Goh, R., Goh, D., & Ellepola, H. (2018). Perineal tears – A review. Australian Journal of General Practice,47(1–2), 35–38. https://doi.org/10.31128/afp-09-17-4333

Gupta, J. K., Sood, A., Hofmeyr, G. J., & Vogel, J. P. (2017). Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews2017(5). https://doi.org/10.1002/14651858.cd002006.pub4

Gurol-Urganci, I., Cromwell, D. A., Edozien, L. C., Mahmood, T. A., Adams, E. J., Richmond, D.    H., Templeton, A., & van der Meulen, J. H. (2013). Third- and fourth-degree perineal    tears among primiparous women in England between 2000 and 2012: time trends         and risk factors. BJOG : an international journal of obstetrics and   gynaecology120(12), 1516–1525. https://doi.org/10.1111/1471-0528.12363

Healy, M., Nyman, V., Spence, D., Otten, R. H. J., & Verhoeven, C. J. (2020). How do midwives facilitate women to give birth during physiological second stage of labour? A systematic reviewPLOS ONE15(7), e0226502. https://doi.org/10.1371/journal.pone.0226502

Henderson, J., Burns, E. E., Regalia, A. L., Casarico, G., Boulton, M. G., & Smith, L. A. (2014). Labouring women who used a birthing pool in obsteric units in Italy: prospective observational study. BMC Pregnancy and Childbirth14(1). https://doi.org/10.1186/1471-2393-14-17

Jiang, H., Qian, X., Carroli, G., & Garner, P. (2017). Selective versus routine use of episiotomy for vaginal birth. Cochrane Database of Systematic Reviews2017(2). https://doi.org/10.1002/14651858.cd000081.pub3

Johnson, A., Thakar, R., & Sultan, A. H. (2012). Obstetric perineal wound infection: is there underreporting? British Journal of Nursing21(Sup5), S28–S35. https://doi.org/10.12968/bjon.2012.21.sup5.s28

Kalis, V., Landsmanova, J., Bednarova, B., Karbanova, J., Laine, K., & Rokyta, Z. (2011). Evaluation of the incision angle of mediolateral episiotomy at 60 degrees. International Journal of Gynecology & Obstetrics112(3), 220–224. https://doi.org/10.1016/j.ijgo.2010.09.015

Kalis, V., Laine, K., De Leeuw, J., Ismail, K., & Tincello, D. (2012). Classification of episiotomy: towards a standardisation of terminology. BJOG: An International Journal of Obstetrics & Gynaecology119(5), 522–526. https://doi.org/10.1111/j.1471-0528.2011.03268.x

Kamisan Atan, I., Shek, K., Langer, S., Guzman Rojas, R., Caudwell-Hall, J., Daly, J., & Dietz, H. (2016). Does the Epi-No®birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology123(6), 995–1003. https://doi.org/10.1111/1471-0528.13924

Kibuka, M., & Thornton, J. G. (2017). Position in the second stage of labour for women with epidural anaesthesia. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd008070.pub3

Klein, M. C., Gauthier, R. J., Jorgensen, S. H., Robbins, J. M., Kaczorowski, J., Johnson, B., Corriveau, M., Westreich, R., Waghorn, K., Gelf, M. M., Guralnick, M. S., Luskey, G. W., & Joshi, A. K. (1992). Does Episiotomy Prevent Perineal Trauma and Pelvic Floor Relaxation? Obstetrical & Gynecological Survey49(4), 238–239. https://doi.org/10.1097/00006254-199404000-00008

Klein, M. C., Gauthier, R. J., Robbins, J. M., Kaczorowski, J., Jorgensen, S. H., Franco, E. D., Johnson, B., Waghorn, K., Gelfand, M. M., Guralnick, M. S., Luskey, G. W., & Joshi, A. K. (1994). Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. American Journal of Obstetrics and Gynecology171(3), 591–598. https://doi.org/10.1016/0002-9378(94)90070-1

KNOV. (2018). Factsheet Episiotomiehttps://www.knov.nl/zoeken/document?documentRegistrationId=10813446

KNOV. (2020, maart). Factsheet Vermoeden van Macrosomiehttps://www.knov.nl/kennis-en-scholing/vakkennis-en-wetenschap/vakkennis?componentid=5505033&title=Macrosomie%25252f%252bPositieve%252bdiscongruentie%25252f%252bLGA#:~:text=De%20factsheet%20%27Vermoeden%20van%20macrosomie%E2%80%99%20beschrijft%20de%20screening,inleiden%20van%20de%20baring%20bij%20vermoeden%20van%20macrosomie.

Kopas, M. L. (2014). A Review of Evidence-Based Practices for Management of the Second Stage of Labor. Journal of Midwifery & Women’s Health59(3), 264–276. https://doi.org/10.1111/jmwh.12199

Laine, K., Gissler, M., & Pirhonen, J. (2009). Changing incidence of anal sphincter tears in four Nordic countries through the last decades. European Journal of Obstetrics & Gynecology and Reproductive Biology146(1), 71–75. https://doi.org/10.1016/j.ejogrb.2009.04.033

Landy, H. J., Laughon, S. K., Bailit, J. L., Kominiarek, M. A., Gonzalez-Quintero, V. H., Ramirez, M., Haberman, S., Hibbard, J., Wilkins, I., Branch, D. W., Burkman, R. T., Gregory, K., Hoffman, M. K., Learman, L. A., Hatjis, C., VanVeldhuisen, P. C., Reddy, U. M., Troendle, J., Sun, L., & Zhang, J. (2011). Characteristics Associated With Severe Perineal and Cervical Lacerations During Vaginal Delivery. Obstetrics & Gynecology117(3), 627–635. https://doi.org/10.1097/aog.0b013e31820afaf2

Langer, B., & Minetti, A. (2006). Complications immédiates et à long terme de l’épisiotomie     [Immediate and long term complications of episiotomy]. Journal de gynecologie,            obstetrique et biologie de la reproduction35(1 Suppl), 1S59–1S67.

Lappen, J. R., & Gossett, D. R. (2010). Changes in episiotomy practice: evidence-based medicine in action. Expert Review of Obstetrics & Gynecology5(3), 301–309. https://doi.org/10.1586/eog.10.21

Lee, N., Firmin, M., Gao, Y., & Kildea, S. (2018). Perineal injury associated with hands     on/hands poised and directed/undirected pushing: A retrospective cross-sectional            study of non-operative vaginal births, 2011-2016. International journal of nursing          studies83, 11–17. https://doi.org/10.1016/j.ijnurstu.2018.04.002

Leeman, L., Fullilove, A. M., Borders, N., Manocchio, R., Albers, L. L., & Rogers, R. G. (2009). Postpartum Perineal Pain in a Low Episiotomy Setting: Association with Severity of Genital Trauma, Labor Care, and Birth Variables. Birth36(4), 283–288. https://doi.org/10.1111/j.1523-536x.2009.00355.x

Leeman, L., Rogers, R., Borders, N., Teaf, D., & Qualls, C. (2016). The Effect of Perineal   Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a                    Prospective Cohort of Nulliparous Women. Birth (Berkeley, Calif.)43(4), 293–302.             https://doi.org/10.1111/birt.12258

Lewis, C., Williams, A. M., & Rogers, R. G. (2007). Postpartum anal sphincter lacerations in a population with minimal exposure to episiotomy and operative vaginal delivery. International Urogynecology Journal19(1), 41–45. https://doi.org/10.1007/s00192-007-0402-0

Lund, N. S., Persson, L. K., Jangö, H., Gommesen, D., & Westergaard, H. B. (2016). Episiotomy in vacuum-assisted delivery affects the risk of obstetric anal sphincter injury: a systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology207, 193–199. https://doi.org/10.1016/j.ejogrb.2016.10.013

Amorim, M., Coutinho, I. C., Melo, I., & Katz, L. (2017). Selective episiotomy vs. implementation of a non-episiotomy protocol: a randomized clinical trial. Reproductive Health14(1). https://doi.org/10.1186/s12978-017-0315-4

Macleod, M., Strachan, B., Bahl, R., Howarth, L., Goyder, K., Van de Venne, M., & Murphy, D. (2008). A prospective cohort study of maternal and neonatal morbidity in relation to use of episiotomy at operative vaginal delivery. BJOG: An International Journal of Obstetrics & Gynaecology115(13), 1688–1694. https://doi.org/10.1111/j.1471-0528.2008.01961.x

Meyvis, I., Rompaey, B., Goormans, K., Truijen, S., Lambers, S., Mestdagh, E., & Mistiaen, W. (2012). Maternal Position and Other Variables: Effects on Perineal Outcomes in 557 Births. Birth39(2), 115–120. https://doi.org/10.1111/j.1523-536x.2012.00529.x

NVOG (2005). VAGINALE KUNSTVERLOSSING (VACUUMEXTRACTIE, FORCIPALE EXTRACTIE). https://www.nvog.nl/wp-content/uploads/2017/12/Vaginale-kunstverlossing-vacuumextractie-forcipale-extractie-1.0-20-05-2005.pdf NVOG. (2013). Totaalruptuur – Richtlijn – Richtlijnendatabase. Richtlijnendatabase. Geraadpleegd op 1 april 2022, van https://richtlijnendatabase.nl/richtlijn/totaalruptuur/totaalruptuur_-_startpagina.html

O’CONNELL, H. E., & DeLANCEY, J. O. (2005). CLITORAL ANATOMY IN NULLIPAROUS, HEALTHY, PREMENOPAUSAL VOLUNTEERS USING UNENHANCED MAGNETIC RESONANCE IMAGING. Journal of Urology173(6), 2060–2063. https://doi.org/10.1097/01.ju.0000158446.21396.c0

Patel, A., Hung, J., Castro, M., Plochocki, J. H., & Hall, M. I. (2018). Midline Episiotomy May Pose Less Risk of Nerve Damage Than Mediolateral Episiotomy: A Cadaveric Anatomical Study. The FASEB Journal32(S1). https://doi.org/10.1096/fasebj.2018.32.1_supplement.516.4

Peristat.nl. (2020). Peristat. Geraadpleegd op 15 juni 2022, van https://www.peristat.nl:443/

Reed, R. (2018). Perineal ‘Bundles’ and Midwifery. MidwifeThinking. Geraadpleegd op 11 april 2022, van https://midwifethinking.com/2018/05/09/the-perineal-bundle-and-midwifery/

Reed, R. (2019, 6 september). Perineal Protectors? MidwifeThinking. Geraadpleegd op 11 april 2022, van https://midwifethinking.com/2016/01/13/perineal-protectors/

RIVM. (2014). Zorgbalans (Nr. 2014–0038). https://www.rivm.nl/bibliotheek/rapporten/2014-0038.pdf

Ruckhäberle, E., Jundt, K., Bäuerle, M., Brisch, K. H., Ulm, K., Dannecker, C., & Schneider, K.      T. (2009). Prospective randomised multicentre trial with the birth trainer EPI-NO for           the prevention of perineal trauma. The Australian & New Zealand journal of       obstetrics & gynaecology49(5), 478–483. https://doi.org/10.1111/j.1479-      828X.2009.01044.x

Sagi-Dain, L., & Sagi, S. (2015). Morbidity associated with episiotomy in vacuum delivery: a systematic review and meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology122(8), 1073–1081. https://doi.org/10.1111/1471-0528.13439

Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews2016(4). https://doi.org/10.1002/14651858.cd004667.pub5

Seijmonsbergen-Schermers, A., De Vries, R., & Goodarzi, B. (2019). Weg met de Noorse handgreep. Tijdschrift voor Verloskundigen2019(2). https://research.vumc.nl/ws/portalfiles/portal/9717167/

Seijmonsbergen_Schermer_Goodarzi_2019_Weg_met_de_Noorse_handgreep_Tvv.pdf Seijmonsbergen-Schermers, A. E. (2020a). Intervene or Interfere? Variations in Childbirth Interventions and Episiotomy in Particularhttps://research.vu.nl/ws/portalfiles/portal/118710447/137947.pdf

Seijmonsbergen-Schermers, A. E. (2020b, 22 mei). Variations in use of childbirth interventions in 13 high-income countries: A multinational cross-sectional study. Plos Medicine. Geraadpleegd op 5 april 2022, van https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003103

Shmueli, A., Gabbay Benziv, R., Hiersch, L., Ashwal, E., Aviram, R., Yogev, Y., & Aviram, A. (2016). Episiotomy – risk factors and outcomes. The Journal of Maternal-Fetal & Neonatal Medicine30(3), 251–256. https://doi.org/10.3109/14767058.2016.1169527

Simic, M., Cnattingius, S., Petersson, G., Sandström, A., & Stephansson, O. (2017). Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study. BMC Pregnancy and Childbirth17(1). https://doi.org/10.1186/s12884-017-1251-6

Sultan, A., & Leeuw, J. (2021). Episiotomy and operative vaginal delivery: do we need more evidence? BJOG: An International Journal of Obstetrics & Gynaecology128(10), 1672–1673. https://doi.org/10.1111/1471-0528.16783

Thornton, J. G., & Dahlen, H. G. (2020). The UK Obstetric Anal Sphincter Injury (OASI) Care        Bundle: A critical review. Midwifery90, 102801.             https://doi.org/10.1016/j.midw.2020.102801

Ulfsdottir, H., Saltvedt, S., & Georgsson, S. (2018). Waterbirth in Sweden – a comparative study. Acta Obstetricia et Gynecologica Scandinavica97(3), 341–348. https://doi.org/10.1111/aogs.13286

Verghese, T. S., Champaneria, R., Kapoor, D. S., & Latthe, P. M. (2016). Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis. International Urogynecology Journal27(10), 1459–1467. https://doi.org/10.1007/s00192-016-2956-1

Walker, C., Rodríguez, T., Herranz, A., Espinosa, J. A., Sánchez, E., & Espuña-Pons, M. (2012). Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma. International Urogynecology Journal23(9), 1249–1256. https://doi.org/10.1007/s00192-012-1675-5

Niet Ingeschreven
Word lid en lees het hele artikel

> Bevat

  • 14 Hoofdstukken

Reacties