Abstract
Perineal trauma affects 80% of women during parturition with nearly 50% requiring suturing. All clinicians practicing obstetrics should be trained in accurately diagnosing and classifying perineal trauma and rectal examination is an integral component of management. An episiotomy is a grade 2 perineal tear and is an incision made to enlarge the vaginal outlet to facilitate delivery of the foetus. This should be mediolateral to avoid injury to the anal sphincter. Clear guidance is provided on the indications for an episiotomy and the technique to be adopted.
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References
Ten Years of Maternity Claims: An Analysis of NHS Litigation Authority Data. ISBN: 978–0–9565019-2-9. http://www.nhsla.com/safety/Documents/Ten%20Years%20of%20Maternity%20Claims%20-%20An%20Analysis%20of%20the%20NHS%20LA%20Data%20-%20October%202012.pdf.
Sultan AH, Thakar R, Fenner D. Perineal and anal sphincter trauma. London: Springer; 2007. p. 13–32.
RCOG Greentop guideline 29: the management of third and fourth-degree perineal tears: RCOG June 2015, www.rcog.org.uk.
Intrapartum care. National Institute of Health and Care Excellence (2014), [CG190]. London: www.nice.org.uk/guidance/cg190.
Kalis V, Landsmanova J, Bednarova B, Karbanova J, Laine K, Rokyta Z. Evaluation of the incision angle of mediolateral episiotomy at 60 degrees. Int J Gynecol Obstet. 2011;112:220–4.
El-Din AS, Kamal MM, Amin MA. Comparison between two incision angles of mediolateral episiotomy in primiparous women: a randomised controlled trial. J Obstet Gynaecol Res. 2014;40:1877–82.
Freeman RM, Hollands H, Barron L, Kapoor DS. Cutting a Mediolateral Episiotomy at the Correct Angle: Evaluation of a new device: The Episcissors-60. Med Devices (Auckl). 2014;7:23–8. https://doi.org/10.2147/MDER.S60056.eCollection2014.
Sawant G, Kumar D. Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(®). Med Devices (Auckl). 2015;8:251–4. https://doi.org/10.2147/MDER.S83360.eCollection2015.
Eogan M, Daly L, O’Connell PR, O’Herlihy C. Does the angle of episiotomy affect the incidence of anal sphincter injury? BJOG. 2006;113:190–4.
Stedenfeldt M, Pirhonen J, Blix E, Wilsqaard T, Vonen B, Qian P. Episiotomy characteristics and risks for obstetric anal sphincter injury: a case-control study. BJOG. 2012;119:724–30.
Evidence Based Guidelines for Midwifery-Led Care in Labour ©The Royal College of Midwives 2012.
Sultan AH, Ritchie A, Mooney G. Obstetric anal sphincter injuries: Review of recent medico-legal aspects. Clinical Risk. 2016;0(0):1–4. https://doi.org/10.1177/1356262216676131:.
Gurol-Urganci I, Cromwell D, Edozien L, Mahmood T, Adams E, Richmond D, Templeton A, van der Meulen J. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG. 2013;120:1516–25.
Verghese TS, Champaneria R, Kapoor DS, Latthe PM. Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis. Int Urogynecol J. 2016;27(10):1459–67. https://doi.org/10.1007/s00192-016-2956-1. Epub 2016 Feb 19.
Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017;(2):CD000081.
Andrews V, Thakar R, Sultan AH, Jones PW. Are mediolateral episiotomies actually mediolateral? BJOG. 2005;112(8):1156.
Andrews V, Thakar R, Sultan AH, Jones PW. Occult anal sphincter injuries—myth or reality? BJOG. 2006;113:195–200.
Conflicts of Interest
DS Kapoor is a co-inventor of the EPISCISSORS-60 episiotomy scissors. He is a shareholder of MEDINVENT LTD, the company that owns the commercial rights to the scissors.
AH Sultan-none.
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Kapoor, D.S., Sultan, A.H. (2018). Perineal Trauma and Episiotomy. In: Jha, S., Ferriman, E. (eds) Medicolegal Issues in Obstetrics and Gynaecology. Springer, Cham. https://doi.org/10.1007/978-3-319-78683-4_35
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DOI: https://doi.org/10.1007/978-3-319-78683-4_35
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