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Back to Gynecology Articles

Monday, 3rd May 2004

 

Another study supports current medical thinking that routine episiotomies bring about increased morbidity.

 
 

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An Italian study published in this week's edition of Obstetrics & Gynecology, examined the effect of mediolateral episiotomy on pelvic floor strength and dysfunction (urinary and anal incontinence, genital prolapse).

An episiotomy is a surgical incision made to enlarge the vaginal opening during childbirth to assist delivery of the baby. This incision can be midline or at an angle from the posterior end of the vulva. It should be performed under local anaesthetic and should, of course, be sutured closed after delivery.

Proponents of episiotomies say it helps to lessen perineal trauma, minimize postpartum pelvic floor dysfunction, reduce blood loss at delivery, and protect against neonatal trauma.

This is not the only study showing that episiotomies did not, in fact, reduce the incidence of serious perineal lacerations but increased them. Having an episiotomy may increase perineal pain in the postpartum period. This can result in trouble defecating, much to the new mother's despair.

Study details

The Italian study consisted of five hundred nineteen primiparous (pregnant for the first time) women who were enrolled 3 months after vaginal delivery. They were then divided in 2 groups those who received mediolateral episiotomy and women with intact perineum and first- and second-degree spontaneous perineal lacerations. Each woman was questioned about related symptoms and examined by digital test, vaginal perineometry, and uroflowmetric stop test score to estimate pelvic floor strength.

The result showed no significant difference was found with regard to the incidence of urinary incontinence and anal incontinence and genital prolapse, whereas dyspareunia and perineal pain were significantly higher in the episiotomy group. As regards pelvic floor strength, episiotomy was associated with significantly worse results. This is in accordance with current medical thinking that routine episiotomies are probably unnecessary and only bring about increased morbidity.

Episiotomies, however, may be indicated if there is any sign of fetal distress while the baby is in the birth canal or there are clinical indications to deliver the baby quickly. Perineal massage in the period prior to childbirth is intended to reduce the need for episiotomy, by making the perineum more flexible.

References

Andrea Sartore, MD, Francesco De Seta, MD, Gianpaolo Maso, MD, Roberto Pregazzi, MD, Eva Grimaldi, MD and Secondo Guaschino, MD. The Effects of Mediolateral Episiotomy on Pelvic Floor Function After Vaginal Delivery. Obstet Gynecol 103: 669-673.

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