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Back to Gynecology Articles
Monday, 3rd May 2004
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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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