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.
Woolley RJ. Benefits and risks of episiotomy: a review of the English-language literature since 1980. Obstet Gynecol Surv 1995;50:806–820PubMedCrossRefGoogle Scholar
Lappen R. J, Gossett R. Changes in episiotomy practice: evidence-based medicine in action. Expert Rev of Obstet Gynecol. 2010;5: 301–309CrossRefGoogle Scholar
Shiono P, Klebanoff MA, Carey JC. Midline episiotomies: more harm than good? Obstet Gynecol 1990;75:765–770PubMedGoogle Scholar
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
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
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
Jovanovic N, Terzic M, Dotlic J, Aleksic S. Prevention of Postpartal Endometritis: Antibiotic of Choice. Srp Arh Celok Lek 2009; 137:506–510PubMedCrossRefGoogle Scholar
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
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
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
Langer B, Minetti A. Immediate and long term complications of episiotomy. J Gynecol Obstet Biol Reprod 2006; 35:1S59–1S67Google Scholar
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
Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2009:1:CD000081PubMedGoogle Scholar
Goldman JC, Robinson J.N.The role of episiotomy in current obstetric practice. Semin Perinatol. 2003; 27: 3–12CrossRefGoogle Scholar
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
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
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
Eason E, Labrecque M, Wells G, Feldman P. Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol 2000;95:464–471PubMedCrossRefGoogle Scholar
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
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
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
Rockner G. Urinary incontinence after perineal trauma at childbirth. Scand J Caring Sci 1990;4:169–172PubMedGoogle Scholar
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
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
Andrews V, Sultan AH, Thakar R, Jones PW. Risk factors for obstetric anal sphincter injury: a prospective study. Birth 2006; 33:117–122PubMedCrossRefGoogle Scholar
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
Signorello LB, Harlow BL, Chekos AK, Repke JT. Midline episiotomy and anal incontinence: retrospective cohort study.BMJ 2000;320:86–90PubMedCrossRefGoogle Scholar
Pirro N, Sastre B, Sielezneff I. What are the risk factors of anal incontinence after vaginal delivery? J Chir 2007;144:197–202CrossRefGoogle Scholar
Terzic M. Internal genital organs. In: Milisavljevic M. (Editor): Clinical anatomy. Science, Belgrade, 1996, pp. 436–446Google Scholar
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
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
Ejegard H, Ryding EL, Sjogren B. Sexuality after delivery with episiotomy: A long-term follow-up. Gynecol Obstet Investig 2008; 66:1–7Google Scholar
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
Joshi A, Acharya R. Perineal outcome after restrictive use of episiotomy in primi-gravidas. J Nepal Med Assoc 2009;48:269–272Google Scholar
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
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