Third- and fourth-degree post-delivery perineal tears : retrospective analysis and management adaptation.

editorial reviewedThird- and fourth-degree perineal tears are injuries involving the anal sphincter that occur during vaginal delivery. Their prevalence is between 0.25 and 6 %, which highlights the variability of obstetrical practice among different countries. This type of tear can lead to short- and long-term complications for the mothers, affecting their quality of life. Therefore, it seems essential that their management should be optimal. In this study, we analyzed the records of all women who suffered from an obstetric anal sphincter injury between January 2015 and January 2021. During this period, out of 11222 vaginal deliveries, 61 records (0.54%) were retained. Maternal, fetal, and delivery-related risk factors were studied and were mostly similar to those found in the literature. However, the treatment of these lesions was very heterogeneous among patients and lacked standardization. A better management of these tears through the establishment of a decision algorithm would potentially reduce the long-term morbidity.Les déchirures périnéales des troisième et quatrième degrés sont des lésions entreprenant le sphincter anal et survenant lors de l’accouchement par voie vaginale. Leur prévalence est comprise entre 0,25 et 6 %, ce qui souligne la variabilité de la pratique obstétricale selon les pays. Ce type de lésion peut entraîner des complications à court et long termes pour les patientes, affectant leur qualité de vie. Dès lors, il semble essentiel que leur prise en charge soit optimale. Dans cette étude rétrospective monocentrique, les dossiers des femmes ayant présenté une lésion obstétricale du sphincter anal entre janvier 2015 et janvier 2021 ont été analysés. Durant cette période, sur 11.222 accouchements par voie basse, 61 dossiers (0,54 %) ont été retenus. Les facteurs de risque maternels, fœtaux et liés à l’accouchement ont été étudiés et sont majoritairement similaires à ceux retrouvés dans la littérature. En revanche, la prise en charge de ces lésions était très hétérogène parmi les patientes, avec un manque de standardisation. Une meilleure gestion de ces déchirures via l’instauration d’un algorithme décisionnel permettrait potentiellement d’en diminuer la morbidité à long terme

European security governance after the Lisbon Treaty: Neighbours and new actors in a changing security environment

The EU has been making strong inroads into the realm of security over the last few years. This is a remarkable development since security matters used to be the preserve of states. The EU has generally been considered a rather weak security actor. However, it is necessary to remember that any assessment of the EU’s role in international security is always underpinned by a specific understanding of security, although this may often be left implicit. This special issue – and, indeed, the European Security and Supranational Governance Conference and the whole EUSIM project – are based on a broad understanding of security. We consider that security concerns are increasingly triggered by challenges such as terrorism, climate change, mass migration flows and many other ‘non-traditional’ security issues. The articles presented in this special issue all testify to the breadth of the EU security agenda as they all try to capture some aspects of the EU’s fast changing security policies following the entry into force of the Lisbon Treaty on 1 December 2009. There are several common themes stemming from a combined reading of the various articles gathered in this special issue. One of the themes that emerges particularly strongly from the various analyses is the existence of a complex relationship between values and security at the heart of several EU policies, particularly in relation to its neighbourhood. As emphasized by the various contributors to this special issue, it appears that the EU has sought to simultaneously pursue its security objectives and spread its values, such as democracy, rule of law and human rights, by encouraging reforms in its neighbourhood. However, it is increasingly evident that there are tensions, and perhaps even contradictions, between these two objectives. We argue in this introduction that it is only one of the challenges faced by the EU that can be illuminated and better understood by considering another strand of literature with which there has been little engagement in EU studies to date – the literature on human security