Episiotomy – risk factors and outcomes

Abstract

Several risk factors for mediolateral episiotomy exist. Episiotomy does not protect nulliparous women, and may be associated with an increased risk for multiparous, for OASI. Therefore, the practice of routine episiotomy should be abandoned, and the practice of selective episiotomy reconsidered.

Perineal tears – A review

“…Depending on the study, the mediolateral episiotomy has been found to lower the incidence of OASI in spontaneous vaginal deliveries. 19 Other studies, however, have found that episiotomies were not protective against severe perineal lacerations, 8,9,20 and can actually increase the risk of third-degree and fourth-degree perineal tears in women who are multiparous. 20 This is potentially due to the difficulty in correctly estimating the episiotomy angles in patients, as perineal distension occurs at crowning of the fetal head.…”

“…19 Other studies, however, have found that episiotomies were not protective against severe perineal lacerations, 8,9,20 and can actually increase the risk of third-degree and fourth-degree perineal tears in women who are multiparous. 20 This is potentially due to the difficulty in correctly estimating the episiotomy angles in patients, as perineal distension occurs at crowning of the fetal head. 11,17 A recent Cochrane review concluded that 'routine' episiotomy is not justified for women in whom no instrumental delivery is intended.…”

Episiotomie

“…Für die Durchführung einer Episiotomie bei der Geburt lassen sich Risikofaktoren benennen. Diese sindentsprechend einer Studie an 41 347 Frauen: ▪ Erstgebärende, ▪ ein höheres mütterliches Alter, ▪ das Gestationsalter, ▪ Verfahren der Regionalanästhesie, ▪ die Geburtseinleitung und ▪ das Geburtsgewicht [17].…”

“…Demgegenüber stehen Auswertungen, die bei einer vaginal-operativen Entbindung unter Einbezug einer medianen oder mediolateralen Episiotomie ein erheblich höheres Risiko für eine Analinkontinenz zeigen konnten, sodass auch hier der Gebrauch dieser Episiotomie-Formen diesbezüglich in der Kritik steht [34]. Eine an 41 347 Frauen mit Einlingsentbindungen durchgeführte retrospektive Arbeit stützt diese Ergebnisse [17].…”

Prática da episiotomia durante a assistência ao parto: tendência e fatores de risco em uma coorte retrospectiva de cinco anos

“…The fear of perineal tears 44,45 and other obstetric complications 47 related to childbirth among clinical staff may explain these results. Nonetheless, a hypothetically decreased elasticity of the perineum as a reason for the significantly higher rate of anal sphincter injuries in older women reinforced by some researchers is controversial.…”