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Episiotomy in modern clinical practice: friend or foe?

  • Maurizio SeratiEmail author
  • Stefano Salvatore
  • Diaa Rizk
Clinical Opinion
  • 119 Downloads

Abstract

The Cochrane library first published a meta-analysis in 2000 on the role of the episiotomy in modern clinical practice, which concluded that only a policy of selective episiotomy is acceptable with evidence-based improvement in maternal health compared with routine episiotomy. Many years later, however, the new version of the Cochrane meta-analysis changed the previous recommendations in that the selective use of episiotomy could not be considered beneficial in all cases. A selective policy is associated with a statistically significant reduction in severe perineal and/or vaginal trauma, whereas routine episiotomy seems to protect against these complications only after instrumental deliveries. Both in the short and the long term, selective medio-lateral episiotomy has no additional beneficial effects without clear evidence of causing harm to the mother or baby.

Keywords

Anal incontinence Episiotomy Urinary incontinence Pelvic floor dysfunction Vaginal delivery 

Notes

Compliance with ethical standards

Conflicts of interest

None.

References

  1. 1.
    Carroli G, Belizan J. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2000;2:CD000081.Google Scholar
  2. 2.
    Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2009;1:CD000081.Google Scholar
  3. 3.
    Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017;2:CD000081.Google Scholar
  4. 4.
    Clesse C, Lighezzolo-Alnot J, De Lavergne S, Hamlin S, Scheffler M. Statistical trends of episiotomy around the world: Comparative systematic review of changing practices. Health Care Women Int. 2018;39:644–62.CrossRefGoogle Scholar
  5. 5.
    World Health Organization. Appropriate technology for birth. Lancet. 1985;2:436–7.Google Scholar
  6. 6.
    Klein MC. Use of episiotomy in the United States. Birth. 2002;29:74–6.CrossRefGoogle Scholar
  7. 7.
    Third- and fourth-degree perineal tears, Management (2015) Royal College of Obstetricians and Gynaecologists: Green-top Guideline No. 29.Google Scholar
  8. 8.
    Rizk DEE, Abadir MN, Thomas LB, Abu-Zidan F. Determinants of the length of episiotomy or spontaneous posterior perineal lacerations during vaginal birth. Int Urogynecol J. 2005;16:395–400.CrossRefGoogle Scholar
  9. 9.
    Bø K, Hilde G, Tennfjord MK, Engh ME. Does episiotomy influence vaginal resting pressure, pelvic floor muscle strength and endurance, and prevalence of urinary incontinence 6 weeks postpartum? Neurourol Urodyn. 2017;36:683–6.CrossRefGoogle Scholar
  10. 10.
    Handa VL, Blomquist JL, McDermott KC, Friedman S, Muñoz A. Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012;119:233–9.CrossRefGoogle Scholar
  11. 11.
    Blomquist JL, McDermott K, Handa VL. Pelvic pain and mode of delivery. Am J Obstet Gynecol. 2014;210:423.e1–6.CrossRefGoogle Scholar
  12. 12.
    Van Bavel J, Hukkelhoven CWPM, de Vries C, Papatsonis DNM, de Vogel J, Roovers JWR, et al. The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of a national registry. Int Urogynecol J. 2018;29:407–13.CrossRefGoogle Scholar
  13. 13.
    Sagi-Dain L, Bahous R, Caspin O, Kreinin-Bleicher I, Gonen R, Sagi S. No episiotomy versus selective lateral/mediolateral episiotomy (EPITRIAL): an interim analysis. Int Urogynecol J. 2018;29:415–23.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Urogynecology UnitUniversity of InsubriaVareseItaly
  2. 2.Urogynaecology Unit, Obstetrics and Gynecology Unit, IRCCS San Raffaele HospitalVita-Salute San Raffaele UniversityMilanItaly
  3. 3.Department of Obstetrics and Gynecology, College of Medicine and Medical SciencesArabian Gulf UniversityManamaBahrain

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