Episiotomy: the final cut?

Steiner, Naama; Weintraub, Adi; Wiznitzer, Arnon; Sergienko, Ruslan; Sheiner, Eyal
December 2012
Archives of Gynecology & Obstetrics;Dec2012, Vol. 286 Issue 6, p1369
Academic Journal
Objective: To investigate whether episiotomy prevents 3rd or 4th degree perineal tears in critical conditions such as shoulder dystocia, instrumental deliveries (vacuum or forceps), persistent occiput-posterior position, fetal macrosomia (>4,000 g), and non-reassuring fetal heart rate (NRFHR) patterns. Methods: A retrospective study comparing 3rd and 4th degree perineal tears during vaginal deliveries with or without episiotomy, in selected critical conditions was performed. Multiple gestations, preterm deliveries (<37 weeks' gestation) and cesarean deliveries were excluded from the analysis. Stratified analysis (using the Mantel-Haenszel technique) was used to obtain the weighted odds ratio (OR), while controlling for these variables. Results: During the study period, there were 168,077 singleton vaginal deliveries. Of those, 188 (0.1 %) had 3rd or 4th degree perineal tears. Vaginal deliveries with episiotomy had statistically significant higher rates of 3rd or 4th degree perineal tears than those without episiotomy (0.2 vs. 0.1 %; P < 0.001). The association between episiotomy and severe perineal tears remained significant even in the critical conditions. Stratified analysis revealed that the adjusted ORs for 3rd or 4th degree perineal tears in these critical conditions (Macrosomia OR = 2.3; instrumental deliveries OR = 1.8; NRFHR patterns OR = 2.1; occipito-posterior position OR = 2.3; and shoulder dystocia OR = 2.3) were similar to the crude OR (OR = 2.3). Conclusions: Mediolateral episiotomy is an independent risk factor for 3rd or 4th degree perineal tears, even in critical conditions such as shoulder dystocia, instrumental deliveries, occiput-posterior position, fetal macrosomia, and NRFHR. Prophylactic use of episiotomy in these conditions does not seem beneficial if performed to prevent 3rd or 4th degree perineal tears.


Related Articles

  • LEGALLY SPEAKING. Traction blamed for brachial plexus injury. COLLINS, DAWN // Contemporary OB/GYN;Nov2010, Vol. 55 Issue 11, p32 

    The article discusses an Illinois medical court case in 1994 in which a woman delivered an infant suffering from C-8 brachial plexus palsy and deformity of right arm and hand, filed a lawsuit against the obstetrician for excessive application of traction to the infant's head and neck during...

  • LEGALLY SPEAKING. Collins, Dawn // Contemporary OB/GYN;Aug2006, Vol. 51 Issue 8, p26 

    The article provides information on various cases of medical malpractice in obstetrics and gynecology in the U.S. A woman from California sued an obstetrician in 2002 whom she claimed had severely injured her baby after encountering a shoulder dystocia. In 1996, a couple from New York sued...

  • Failure to offer C/S for suspected macrosomia.  // Contemporary OB/GYN;Jan2007, Vol. 52 Issue 1, p41 

    The article deals with the allegations of a woman that the hospital and her physicians failed to inform her of the diagnosis of macrosomia and to offer her a caesarean section (C/S). The physician who delivered the patient's baby used a vacuum and continued with the procedure despite...

  • CAESAREAN SECTIONS IN A SECONDARY CARE HOSPITAL OF A METROPOLITAN CITY. Bachani, Sumitra // Journal of Family Welfare;Dec2006, Vol. 52 Issue 2, p86 

    The article discusses the study on the factors which can be controlled to influence the caesarean section rates in India. The study concluded that caesarian section rates reflect the rate of a medically low risk population in whom the indications for caesarian section are further reduced. In...

  • Variables influencing the integrity of lower uterine segment in post-cesarean pregnancy. Brahmalakshmy, B.; Kushtagi, Pralhad // Archives of Gynecology & Obstetrics;Apr2015, Vol. 291 Issue 4, p755 

    Background: There is significant increase in proportion of cases with previous cesarean delivery requiring obstetric care. The available literature fails to provide uniform opinion on each woman's characteristics to identify risk of uterine rupture while planning trial of labor after cesarean....

  • Can We Document Term Elective Delivery Prior To 39 Weeks From Billing/ Coding Databases? Manning, M. J.; Von Bargen, E.; Cain, J.; Klugman, R. // Internet Journal of Gynecology & Obstetrics;2013, Vol. 17 Issue 1, p1 

    Objective: To evaluate whether billing/coding data and point of care data are discrepant in regards to the rate of elective delivery between 37.0 and 38.6 weeks and explore the direction and depth of discrepancies regarding indications for delivery. Methods: All Deliveries between April 1, 2006...

  • Audit of Primary Caesarean Sections in Nulliparae Seen in ABUTH Kaduna. Kolawole, A. O. D.; Onwuhuafua, P.; Adesiyun, G.; Oguntayo, A.; Mohammed-Duro, A. // Australian Journal of Basic & Applied Sciences;2011, Vol. 5 Issue 6, p1088 

    BACKGROUND: Caesarean Section (CS) often affects the subsequent obstetric career of women. A review of indications for first Caesarean sections in nulliparae seen in Ahmadu Bello University Teaching Hospital Kaduna (ABUTHK) is timely and will influence interventions aimed at reducing the overall...

  • Vaginal birth after cesarean section: A retrospective study. Ghafarzadeh, Masoome; Namdari, Mehrdad; Ashraf, Haleh // Pakistan Journal of Medical Sciences;Oct2010, Vol. 26 Issue 4, p987 

    Objective: The rising number of women undergoing elective repeat cesarean has been one of the principal reasons for the steady increase in the cesarean delivery rate. This study aim was to assess vaginal birth rates after cesarean (VBAC) in an educational hospital at Khorramabad, Lorestan....

  • Neonatal Injury at Cephalic Vaginal Delivery: A Retrospective Analysis of Extent of Association with Shoulder Dystocia. Iskender, Cantekin; Kaymak, Oktay; Erkenekli, Kudret; Ustunyurt, Emin; Uygur, Dilek; Yakut, Halil Ibrahim; Danisman, Nuri // PLoS ONE;Aug2014, Vol. 9 Issue 8, p1 

    Purpose: To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics