Restricted use of episiotomy

Saxena, Rajiv Kumar; Sandhu, Gurpreet S.; Babu, KM; Bandol, Halesha; Sharma, Gargi

doi:10.1007/s13224-010-0067-3

Cited by 9 publications

(10 citation statements)

References 6 publications

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“…Thus, it would be fair to conclude that the policy of restricted use of episiotomy has a strong protective effect on the occurrence of perineal lacerations and it significantly contributed to lessen the maternal morbidity. 12 In a study by Clemons et al, the total number of parturients who had perineal lacerations, in the study group was 36%, which was significantly less when compared to 69% in the control group. The anal sphincter laceration rate decreased 44% with the use of mediolateral episiotomy.…”

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confidence: 83%

“…Restricted use of episiotomy led to significant reduction in the incidence of perineal lacerations. 12 As per current study in routine episiotomy n-50 subjects (100%) had to be sutured as episiotomy was given to all cases and 04 of the total 07, vaginal/ paraurethral tears in the routine group were sutured in view of active bleed from the site. In restrictive group n-9 (20%) required suturing out of which 07 were perineal tears and 02 were vaginal / paraurethral tears.…”

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confidence: 96%

“…As per Saxena et al there was no correlation of episiotomy or tears to the maternal age in both the groups. 12 In the study under reference the difference between the mean perineal length of the two groups was assessed and it was found that there was no statistically significant difference between the mean perineal length of two groups. Study by Carroli G et al conducted on 429 women concluded that perineal length was not associated with the risk of perineal tear.…”

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confidence: 99%

“…All these neonates had been delivered with the help of an episiotomy. 12 Murphy et al performed a multi-center pilot randomized controlled trial in Ireland to investigate neonatal trauma in routine versus restrictive use of episiotomy. This is in agreement to our results and did not indicate any significant difference in both primary and secondary outcomes between two mentioned methods.…”

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confidence: 99%

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Comparison of use of restrictive episiotomy versus routine episiotomy in primigravidae undergoing vaginal birth at a tertiary care hospital

Venus

Rao

Prajwal

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Episiotomy is the surgical enlargement of the vaginal orifice by an incision on the perineum during the last part of the second stage of labour or delivery. Episiotomy, incision of the perineum at the time of vaginal childbirth, is a common surgical procedure experienced by women. This study is done to compare use of restrictive episiotomy and routine episiotomy in primigravidae undergoing vaginal birth.Methods: This is a prospective cohort study designed to analyse the outcome of the restrictive use of episiotomy in comparison to routine use of episiotomy. Total 100 primigravidae women reporting to labour room in spontaneous labour/induction of labour were included and two cohorts were formed. Both the cohorts were evaluated during labour, immediate postpartum period and first postnatal day and data was tabulated and analysed.Results: Vaginal and paraurethral tears were noted in 14% primigravidae in the routine episiotomy group and 22.22% in the restrictive episiotomy group with no statistically significant association. Number of cases sustaining perineal tear in restrictive group was 15.55% and extension of episiotomy in the routine group was 26% with no statistically significant association. Requirement of suturing was far less in restrictive group (20%) as compared to routine group (100%), as 64.45% of the patients in restrictive group delivered with an intact perineum. The restrictive use of episiotomy does not prolong the second stage of labour and has requirement of significantly less pain relief compared to the routine group. Complication rate was higher in the routine group and perineal laceration and pain severity, was less in restrictive episiotomy group. However, neonatal complications were similar in the two groups.Conclusions: This study identified fair to good evidence suggesting that immediate outcomes following routine use of episiotomy are no better than those of restrictive use. Indeed, routine use is harmful to the degree that some proportion of women who would have had lesser injury instead had a surgical incision.

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confidence: 83%

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confidence: 96%

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confidence: 99%

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confidence: 99%

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Comparison of use of restrictive episiotomy versus routine episiotomy in primigravidae undergoing vaginal birth at a tertiary care hospital

Venus

Rao

Prajwal

2017

Int J Reprod Contracept Obstet Gynecol

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“…Although it is one of the most commonly performed surgical procedures during delivery, there is extensive disagreement about the necessity and benefits of this procedure [1].…”

Section: Introductionmentioning

confidence: 99%

Post Episiotomy Physical and Physiological Morbidities in Al Azhar University Hospital of Assiut -Upper Egypt

Edessy¹,

Nasr²,

El-Aty³

et al. 2015

SOJGOW

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SOJ Gynecology, Obstetrics and Women's Health Open AccessResearch Article perineal tears was advocated as a benefit of routine episiotomy in primiparous women [5].In the United States, there has been a steady decline in episiotomy rates from 62% in 1987 to 30 -35 % in 2003 [6].Episiotomy, actually increased rates of perineal infection, blood loss, pain during healing, negatively affected body image issues and sexual function, and incidence of injuries to the anal sphincter with subsequent increased risks of incontinence of flatus and fecal material. Multiple studies demonstrated that the routine use of episiotomy did not protect against pelvic relaxation or fetal intracranial hemorrhage [5].Episiotomy may increase perineal pain during postpartum recovery, resulting in trouble defecating, particularly in midline episiotomies. In addition it may complicate sexual intercourse by making it painful and replacing erectile tissues in the vulva with fibrotic tissue [7]. Women who underwent episiotomy reported more painful intercourse and insufficient lubrication 12-18 months after birth, but did not find any problems with orgasm or arousal [8]. Patients and MethodsThis is a prospective case control study conducted on 400 full term pregnant women (primi &second gravidae) from attendants of delivery ward of Obstetrics and Gynecology department of AlAzhar university hospital of Assiut governorate of Upper Egypt. The study was approved by the Regional Committee for Medical and Health Research Ethics of Al Azhar University of Assiut. Pregnancy was singleton term without underlying medical or any pregnancy-related complications for whom spontaneous vaginal delivery was performed.Women were allocated into 2 equal groups (200 for each) according to whether or not episiotomy was performed (Group I = with episiotomy) and (Group II= without episiotomy). An informed signed written consent was obtained from all participants.During intrapartum period, the same standard obstetrical managements were provided in both groups. Each group was AbstractBackground: Episiotomy is performed as one of the most common surgery procedure to facilitate delivery and prevent complications of hard labour in both mother and her neonate. Routine episiotomy is a controversial issue among obstetricians.

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Birth-Related Perineal Trauma in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

Aguiar

Farley

Hope

et al. 2019

Matern Child Health J

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Introduction Birth-related perineal trauma (BPT) is a common consequence of vaginal births. When poorly managed, BPT can result in increased morbidity and mortality due to infections, haemorrhage, and incontinence. This review aims to collect data on rates of BPT in low- and middle-income countries (LMICs), through a systematic review and meta-analysis. Methods The following databases were searched: Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACs), and the World Health Organization (WHO) regional databases, from 2004 to 2016. Cross-sectional data on the proportion of vaginal births that resulted in episiotomy, second degree tears or obstetric anal sphincter injuries (OASI) were extracted from studies carried out in LMICs by two independent reviewers. Estimates were meta-analysed using a random effects model; results were presented by type of BPT, parity, and mode of birth. Results Of the 1182 citations reviewed, 74 studies providing data on 334,054 births in 41 countries were included. Five studies reported outcomes of births in the community. In LMICs, the overall rates of BPT were 46% (95% CI 36–55%), 24% (95% CI 17–32%), and 1.4% (95% CI 1.2–1.7%) for episiotomies, second degree tears, and OASI, respectively. Studies were highly heterogeneous with respect to study design and population. The overall reporting quality was inadequate. Discussion Compared to high-income settings, episiotomy rates are high in LMIC medical facilities. There is an urgent need to improve reporting of BPT in LMICs particularly with regards to births taking in community settings. Electronic supplementary material The online version of this article (10.1007/s10995-019-02732-5) contains supplementary material, which is available to authorized users.

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Restricted use of episiotomy

Cited by 9 publications

References 6 publications

Comparison of use of restrictive episiotomy versus routine episiotomy in primigravidae undergoing vaginal birth at a tertiary care hospital

Comparison of use of restrictive episiotomy versus routine episiotomy in primigravidae undergoing vaginal birth at a tertiary care hospital

Post Episiotomy Physical and Physiological Morbidities in Al Azhar University Hospital of Assiut -Upper Egypt

Birth-Related Perineal Trauma in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

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