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Current approach to episiotomy: Inevitable or unnecessary?

  • Nebojsa S. Jovanovic
  • Dusica M. Kocijancic
  • Milan M. Terzic
Review Article
  • 330 Downloads

Abstract

An episiotomy is a surgical incision through the perineum made to provide sufficient area for the delivery of the infant. About 10 to 95% of women who deliver will have episiotomy depending on which part of the world they are having delivery.

Too early episiotomy causes extensive bleeding and too late episiotomy causes the excessive stretching of a pelvic floor and lacerations could not be prevented.

According to widely accepted arguments, there are many benefits of episiotomy for the neonate: prevention of injuries, shoulder dystocia and mental retardation of the infant. Benefits for the mother are: reduction of severe lacerations, prevention of sexual dysfunction, prevention of urinary and fecal incontinence. But those things could also be complications of episiotomy, if it is being used nonrestrictively. Some other complications are also extensive bleeding, hematoma or infection.

There are many different opinions in literature about using episiotomy restrictively or routinely, so it is the right doubt arisen: is it inevitable or unnecessary?

There is a wide variation in episiotomy practice, and the decision of performing it or not depends of actual clinical situation.

There is still a great need for continuous obstetrics education according to the evidence based guidelines for the patient’s safety.

Keywords

Episiotomy Controversy Risks Benefits Complications 

References

  1. [1]
    Jevremovic M, Terzic M. Contemporary menagement of delivery. In: Bojovic S. (Editor): Human reproduction. Scientific book, Belgrade, 2003, pp. 912–927Google Scholar
  2. [2]
    Allen RE, Hanson RW Jr. Episiotomy in low-risk vaginal deliveries. J Am Board Fam Pract 2005;18:8–12PubMedCrossRefGoogle Scholar
  3. [3]
    ACOG Practice Bulletin. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists Obstet Gynecol 2006;107:957–962Google Scholar
  4. [4]
    Gabbe SG, DeLee JB. The prophylactic forceps operation.1920. Am J Obstet Gynecol 2002;187:254–255PubMedCrossRefGoogle Scholar
  5. [5]
    Woolley RJ. Benefits and risks of episiotomy: a review of the English-language literature since 1980. Obstet Gynecol Surv 1995;50:806–820PubMedCrossRefGoogle Scholar
  6. [6]
    Lappen R. J, Gossett R. Changes in episiotomy practice: evidence-based medicine in action. Expert Rev of Obstet Gynecol. 2010;5: 301–309CrossRefGoogle Scholar
  7. [7]
    Shiono P, Klebanoff MA, Carey JC. Midline episiotomies: more harm than good? Obstet Gynecol 1990;75:765–770PubMedGoogle Scholar
  8. [8]
    Labrecque M, Bailargeon L, Daillaire M, Trembley A, Pinault JJ, Gingras S. Association between median episiotomy and severe perineal lacerations in primiparaous women. Can Med Assoc J 1997; 156: 797–802Google Scholar
  9. [9]
    Fritel X, Schaal JP, Fauconnier A, Bertrand V, Levet C, Pigné A. Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy. Br J Obstet Gynaecol 2008;115:247–252Google Scholar
  10. [10]
    Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J, Lohr N.K Outcomes of Routine Episiotomy: a systematic review. JAMA. 2005;293:2141–2148PubMedCrossRefGoogle Scholar
  11. [11]
    Ramin SM, Gilstrap LC III. Episiotomy and early repair of dehiscence. Clin Obstet Gynecol 1994;37:816–823PubMedCrossRefGoogle Scholar
  12. [12]
    Jovanovic N, Terzic M, Dotlic J, Aleksic S. Prevention of Postpartal Endometritis: Antibiotic of Choice. Srp Arh Celok Lek 2009; 137:506–510PubMedCrossRefGoogle Scholar
  13. [13]
    Zizic V, Plecas D, Velimirovic M, Terzic M. The most frequent bacteriologic causes of puerperal infection. Giorn Mal Inf Parass 1990; 42:563–564Google Scholar
  14. [14]
    Ugwumadu A, Manyonda I, Reid F, Hay P. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a andomised controlled trial. The Lancet 2003; 361: 983–988CrossRefGoogle Scholar
  15. [15]
    Rorbye C, Petersen IS, Nilas L. Postpartum Clostridium sordellii infection associated with fatal toxic shock syndrome. Acta Obstet Gynecol Scand 2000;79:1134–1135PubMedGoogle Scholar
  16. [16]
    Morris WE, Fernández-Miyakawa ME. Toxins of Clostridium perfringens. Rev Argent Microbiol 2009; 41:251–260PubMedGoogle Scholar
  17. [17]
    Langer B, Minetti A. Immediate and long term complications of episiotomy. J Gynecol Obstet Biol Reprod 2006; 35:1S59–1S67Google Scholar
  18. [18]
    Dinulović D, Terzić M. Injuries of the birth canal during childbirth. In: Dinulović D. (Editor). Obstetrics. Službeni glasnik SRJ, Belgrade, 1996, pp. 436–446Google Scholar
  19. [19]
    Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2009:1:CD000081PubMedGoogle Scholar
  20. [20]
    Goldman JC, Robinson J.N.The role of episiotomy in current obstetric practice. Semin Perinatol. 2003; 27: 3–12CrossRefGoogle Scholar
  21. [21]
    Frudinger A, Bartram CI, Spencer JAD, Kamm MA. Perineal examination as a predictor of underlying external anal sphincter damage. Br J Obstet Gynecol 1997; 104:1009–1013CrossRefGoogle Scholar
  22. [22]
    Alperin M, Krohn MA, Parviainen K. Episiotomy and increase in the risk of obstetric laceration in a subsequent vaginal delivery. Obstet Gynecol 2008;111:1274–1278PubMedCrossRefGoogle Scholar
  23. [23]
    Landy HJ, Laughon SK, Bailit JL, Kominiarek MA, Gonzalez-Quintero VH, Ramirez M et al. Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. Obstet Gynecol 2011;117:627–635PubMedCrossRefGoogle Scholar
  24. [24]
    Eason E, Labrecque M, Wells G, Feldman P. Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol 2000;95:464–471PubMedCrossRefGoogle Scholar
  25. [25]
    Persson J, Wolner-Hanssen P, Rydhstroem H. Obstetric risk factors for stress urinary incontinence: A population-based study. Obstet Gynecol 2000;96; 440-445Google Scholar
  26. [26]
    Casey BM, Schaffer JI, Bloom SL, Heartwell SF, McIntire DD, Leveno KJ. Obstetric antecedents for postpartum pelvic floor dysfunction. Am J Obstet Gynecol 2005;192:1655–1662PubMedCrossRefGoogle Scholar
  27. [27]
    Viswanathan M, Hartmann K, Palmieri R, Lux L, Swinson T, Lohr KN et al. The Use of Episiotomy in Obstetrical Care: A Systematic Review. Evid Rep Technol Assess. 2005; 112:1–8Google Scholar
  28. [28]
    Rockner G. Urinary incontinence after perineal trauma at childbirth. Scand J Caring Sci 1990;4:169–172PubMedGoogle Scholar
  29. [29]
    Arrue M, Ibanez L, Paredes J, Murgiondo A., Belar M, Sarasqueta C et al. Stress urinary incontinence six months after first vaginal delivery. Eur J Obstet Gynecol Reprod Biol 2010; 210–214Google Scholar
  30. [30]
    Sartore A, De Seta F, Maso G, Pregazzi R, Grimaldi E, Guaschino S. The effects of mediolateral episiotomy on pelvic floor function after vaginal delivery. Obstet Gynecol 2004;103:669–673PubMedCrossRefGoogle Scholar
  31. [31]
    Andrews V, Sultan AH, Thakar R, Jones PW. Risk factors for obstetric anal sphincter injury: a prospective study. Birth 2006; 33:117–122PubMedCrossRefGoogle Scholar
  32. [32]
    Wheeler T, Richter HE. Delivery method, anal sphincter tears and fecal incontinence: new information on a persistent problem. Curr Opin Obstet Gynecol 2007;19:474–479PubMedCrossRefGoogle Scholar
  33. [33]
    Signorello LB, Harlow BL, Chekos AK, Repke JT. Midline episiotomy and anal incontinence: retrospective cohort study.BMJ 2000;320:86–90PubMedCrossRefGoogle Scholar
  34. [34]
    Pirro N, Sastre B, Sielezneff I. What are the risk factors of anal incontinence after vaginal delivery? J Chir 2007;144:197–202CrossRefGoogle Scholar
  35. [35]
    Terzic M. Internal genital organs. In: Milisavljevic M. (Editor): Clinical anatomy. Science, Belgrade, 1996, pp. 436–446Google Scholar
  36. [36]
    Buhling KJ, Schmidt S, Robinson JN, Klapp C, Siebert G, Dudenhausen JW.Rate of dyspareunia after delivery in primiparae according to mode of delivery. Eur J Obstet Gynecol Reprod Biol. 2006;124:42–46PubMedCrossRefGoogle Scholar
  37. [37]
    Sayasneh A, Pandeva I. Postpartum sexual disfunction. A literature review of risk factors and role of mode of delivery. BJMP 2010; 3:316–320Google Scholar
  38. [38]
    Ejegard H, Ryding EL, Sjogren B. Sexuality after delivery with episiotomy: A long-term follow-up. Gynecol Obstet Investig 2008; 66:1–7Google Scholar
  39. [39]
    Danielsson I, Sjoberg I, Stenlund H, Wikman M. Prevalence and incidence of prolonged and severe dyspareunia in women: results from a population study. Scand J Public Health 2003;31:113–118PubMedCrossRefGoogle Scholar
  40. [40]
    Joshi A, Acharya R. Perineal outcome after restrictive use of episiotomy in primi-gravidas. J Nepal Med Assoc 2009;48:269–272Google Scholar
  41. [41]
    Fritel X. Pelvic floor and pregnancy. Gynecol Obstet Fertil 2010; 38:332–346PubMedCrossRefGoogle Scholar
  42. [42]
    Adamo V, Di Natale W, Meola C, Gilio M, Cavalli S, Ferrari L et al. Endometriosis in episiotomy scar: a case report. 2004;56:735–738Google Scholar
  43. [43]
    Baloglu A, Uysal D, Aslan N, Yigit S. Advanced stage of cervical carcinoma undiagnosed during antenatal period in term pregnancy and concomitant metastasis on episiotomy scar during delivery: a case report and review of the literature. Int JGynecol Cancer. 2007;17:1155–1159CrossRefGoogle Scholar

Copyright information

© © Versita Warsaw and Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Nebojsa S. Jovanovic
    • 1
  • Dusica M. Kocijancic
    • 1
  • Milan M. Terzic
    • 1
    • 2
  1. 1.Clinical Center of SerbiaInstitute of Obstetrics and GynecologyBelgradeSerbia
  2. 2.School of MedicineUniversity of BelgradeBelgradeSerbia

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